Brainstorming before the first simultaneous heart-liver transplant in Vietnam

“The professional council meeting was extremely stressful,” Associate Professor Nguyen Tien Quyet, former Director of Viet Duc Hospital, a leading expert in organ transplantation, said on October 10.

According to Mr. Quyet, the 41-year-old male patient has dilated cardiomyopathy, causing heart, liver, and kidney failure, with life expectancy measured in days. He was admitted to Viet Duc Hospital at the end of September and was kept alive by a heart-lung machine (ECMO). If wean off ECMO, the patient will die immediately. Organ transplant is the last method that can save life. However, when there is a donated organ from a brain-dead donor from Nghe An, doctors have to “weigh and measure” because simultaneous heart and liver transplantation in Vietnam has never been done, especially in severely damaged patients. as severe as this case.

“Patients with heart failure need a heart transplant, of course, but he also has severe liver failure. If he only has a heart transplant, he will have no chance of continuing to live because of liver failure,” Associate Professor Quyet said. This is also a situation that causes doctors to “weigh their brains” and debate heatedly when discussing whether to transplant a patient’s heart and liver at the same time.

Some doctors believe that only a heart transplant should be done, “because with a heart transplant, the liver will recover”. However, the patient’s liver biopsy results later showed that this organ was 50% necrotic, with no chance of recovery, forcing a liver transplant. The remaining 70% of opinions believe that the transplant should not be done at the same time because the patient’s condition is too severe. If it fails, the patient’s chance of survival as well as the two other people waiting for a heart and liver transplant will be lost.

Finally, the Expert Council decided to transplant two organs simultaneously to the above man. “We only dare to give a conservative prognosis of 20%, but doctors still have to try,” said Dr. Duong Duc Hung, Director of Viet Duc Hospital.

Doctor Hung shared that from the moment he made the decision, the two words “failure” never appeared in his mind. The first reason, “the professional council has raised and put down 100 times, calculated all options, and is confident in the doctors’ skills.”

In addition, the brain-dead victim in Nghe An donated many organs, but both his heart and liver were suitable for the 41-year-old man. “This is a coincidence of fate,” said Dr. Hung, adding that the above reasons are the motivation for experts to be determined to save patients by all means.

The economic situation of the organ recipient is difficult. The assets the patient and his wife brought with them totaled 400 million VND while the cost of transplantation and treatment was up to billions of VND. Patients are covered by health insurance, and the hospital finds ways to support the rest.

“We burned incense and prayed to the medical profession professors, Mr. Ton That Tung and Mr. Ton That Bach, for blessings before and after the surgery. With confidence in the hospital’s skills and careful preparation, we The more I believe, the patient will have the opportunity to continue living with his family,” Dr. Hung said.

Immediately after the decision to transplant was made, all departments quickly got involved. A Viet Duc team went to Nghe An to assess brain and organ death, then traveled 300 km back to Hanoi. On the afternoon of October 1, doctors at Viet Duc Hospital performed a heart and liver organ transplant for a male patient.

After 8 hours, the surgery was successful. The Nghe An boy’s heart beats for the first time in the chest of a man in Hanoi. His liver also began to function, secreting bile to help bring blood clotting indexes, liver enzymes and bilirubin gradually back to normal.

At this time, the surgical team dared to “breathe heavily”, but the anesthesia and resuscitation team entered a new battle. Associate Professor, Dr. Luu Quang Thuy, Director of the Center for Anesthesia and Resuscitation, said that organ transplantation has become a routine technique at Viet Duc. But with the first case, simultaneously transplanting two large organs, heart and liver, in a very sick patient, the anesthesia and resuscitation process always faced many risks and pressures.

“We mobilized all the most experienced experts, inviting Prof. Dr. Nguyen Quoc Kinh, a leading scientist in the field, to lead the expertise in resuscitation,” Mr. Thuy said. Thanks to that, the patient has complete control over the function of the transplanted organ during and after surgery.

This transplant is also challenging because the organs are taken in Nghe An – hundreds of kilometers from Viet Duc Hospital. Therefore, optimal resuscitation of the transplanted organ before surgery is very important. This place solved the problem by sending a team to Nghe An to assist in resuscitating the patient before organ donation, helping the organs removed be of the best quality, contributing to the success of the surgery.

Viet Duc Hospital has performed 5 simultaneous transplants, including 2 liver – kidney transplants and 2 heart – kidney transplants. This heart – liver transplant is the first time in Vietnam.

Organ transplantation is one of the most important achievements of human medicine since the 20th century. Vietnam is 50 years behind the world and about 20 years behind other countries in the region, but currently our country’s level of organ transplantation is on par. equal to many countries, according to Associate Professor Quyet. Vietnam has mastered the technique and has continuously performed many multi-organ transplants.

Specifically, from the first kidney transplant in 1992 until now, there have been nearly 9,000 organ transplants performed nationwide. Among them, mainly kidney transplants with more than 8,000 cases; liver transplant about 600; more than 80 heart transplants; lung transplant more than 10; pancreas transplant 1; There are still a number of intestinal and other organ transplants.

Previously, 5 central hospitals (Viet Duc Friendship, Military Central 108, Military Medical 103, Hue Central, Cho Ray) were able to perform organ transplant techniques. Now, the Ministry of Health has licensed 26 hospitals to perform this technique.

Le Nga