Best Practice 1

1.Title of the Practice:Organ Transplantation and Organ Donation

2.Objectives of the Practice

Mahatma Gandhi Hospital (MGH) under the aegis of Mahatma Gandhi University of Medical Sciences and Technology (MGUMST) is a pioneer Institute in the field of organ transplantation not only in the state of Rajasthan at National and Global levels.

Objectives of the practice are-

1. To provide comprehensive, most modern and affordable healthcare to the people needing organ transplantation.

2. To promote awareness, motivate the community and induce a behavioral change in the people towards organ donation especially deceased organ donation.

3. To develop MGH as an apex Institute in the field of organ transplantation encompassing a broad spectrum of kidney, liver, heart, pancreas, bone marrow, small bowel and corneal transplantation.

3.The Context

There is universal shortage of organ donors globally but India lags far behind in comparison to the rest of the world. Nearly every person who dies naturally or in an accident, is a potential organ donor. Even then, innumerable needy patients cannot find an organ donor. When organs are not functioning properly and no treatment works out in last stage, transplantation may be the only option to save the patient and lead a normal and healthy life.

There is a wide gap between patients who need transplant and the organs available, in the country. An estimated 1.8 lakh persons suffer from renal insufficiency every year, however the number of renal transplants done are around 6000 only. Annually about 25 thousand liver transplants are needed in India but about only one thousand five hundred liver transplants are being performed. Only 10-15 heart transplants are done annually in India whereas the requirement is much higher.

4.The Practice

Our state-of-the-art Transplant center is equipped with:

Dedicated 06 (six) Operating Theatres, customized for transplant surgeries. 02 OTs for Kidney Transplant, 02 OTs for heart transplant and 02 OTs for Liver & other Gastrointestinal transplant surgeries.

Dedicated, state-of-the-art post-transplant ICUs (Intensive Care Unit) and step-down units. Advanced blood center facilities for pre and post-transplant cross matching.

High end laboratories for all transplant related tests and investigations, in-house.

Diagnostic and Radiology Facilities which include 3 Tesla MRI, 128 Slice CT scan, machine and high-end Doppler Ultrasound facilities.

Dedicated wards and rooms for transplant patients.

Counselors and Transplant Co-coordinators to take care of all needs. Translators to counsel patients in all languages.

Dedicated help lines and unit managers to take care of treatment needs and requirements. Dedicated and trained nursing staff for pre-operative and post-operative care.

Renal Transplant Center

MGH is at the forefront in providing comprehensive and cutting-edge healthcare to patients needing renal transplants. We have performed 1927kidney transplants so far and are presently doing one renal transplant every calendar day. A multi-disciplinary team of urologists, nephrologists, technicians and paraclinical staff are empowered with state-of-the-art infrastructure and medical instrumentation.

The lifestyle diseases have contributed to an increase in chronic kidney problems. Chronic kidney disease in India is prevalent in approximately 800 per million people. Our hospital is very popular amongst the patients and people from different part of country prefer Mahatma Gandhi Hospital by registering here forlive donor transplant, considering the quality of care provided.

The procedures for kidney transplantation include:

Living donor kidney transplants (Swap and ABO Incompatible) Cadaveric renal transplantation

Laparoscopic donor Nephrectomy

Robotic assisted donor nephrectomy (soon to be started)

The hospital has high end technological infrastructure and medical facilities that allow safer, better and comprehensive medical care with a high success rate. The Institute is also supported by world class services in transfusion medicine, pathology, laboratory medicine, cardiology, endocrinology, nephrology and pulmonology, all of which together give us that extra edge.

Liver, Pancreas and Small Bowel Transplant Center

Every liver transplant is an amalgamation of the highest level of expertise in liver, biliary and vascular surgery, as well as advanced support from experts in liver and biliary surgery, adult and pediatric hepatology, hepatobiliary and transplant anesthesia, critical care, diagnostic and interventional radiology, and liver oncology. Experts from all these specialties have come together under one roof to create an unparalleled oasis of talent at MG hospital and medical college. The liver transplant centre is committed to a scientific, compassionate and patient-friendly approach. So far, we have done 93liver transplants. We have performed 01 pancreas transplant till date, and we are ready to start the small bowel transplant surgery. Liver transplantation adds a significant survival benefit to the patients having NASH (fatty liver inflammation), Liver Cirrhosis (end stage), Liver tumors etc. Pancreas transplantation is highly beneficial for patients with pancreatic and associated tumors.

Heart and lung Transplant

Heart transplant is a very complex surgery and requires expertise of a Cardiothoracic Surgeon trained in transplant, a cardiologist, perfusionist and a dedicated team of paraclinical personnel. Extensive infrastructure is needs for the heart transplant surgery and the post-operative care. Mahatma Gandhi Hospital has all the facilities needed for this surgery at a single point. We have performed Two heart transplant and one lung transplant. We have a list of recipients prepared for both heart and lung transplant, and the surgeries are performed as when the cadaveric organ becomes available, as in this surgery a diseased heart is replaced with a cadaveric donor’s healthy heart.

The center has performed North India First Heart Transplant and First-time Liver and Pancreas Transplant in State of Rajasthan. The center has performed 48 Bone Marrow transplants successfully.

5. Evidence of success

Under the leadership of highly skilled transplant surgeons, MGH has successfully achieved following in last 6 years:

More than 1927 renal transplants including more than 50 ABO incompatible renal transplants, more than 50 swap renal transplants and 17 cadaveric renal transplants.

93 liver transplants

Two heart transplant

One pancreatic transplant One lung transplant

Mahatma Gandhi Hospital is also a recognized center for cornea transplant, bone marrow transplant and skin transplant. The center has performed more than 20 cornea transplants, 48>bone marrow transplants and one skin transplant.

Mahatma Gandhi Hospital under the aegis of MGUMST is first teaching hospital in the state to perform Heart transplant

Pancreatic transplant

Living Donor Liver Transplant Cadaveric Liver Transplant Cadaveric Kidney Transplant

Mahatma Gandhi Hospital has got license for bone transplant and intestine transplant, uterine transplant, arms & limbs transplant as well from Government of Rajasthan.

6.Problems Encountered and Resources Required:

The major problem and challenge that lies ahead is to create awareness amongst the general population about cadaveric organ donation and also, to a certain extent, about related donor organ donation. This can be overcome only by creating more awareness and bringing out successfully treated patients as the ambassadors.

Though, MGH provides the above-mentioned transplant surgeries at the most affordable charges in the State, transplant still remains a costly procedure and post-transplant medication incurs a monthly expenditure from the patient. More philanthropy and social contribution is needed to overcome this problem.

7.Notes

The University plans to enhance the organ donation drive not only in the state of Rajasthan but whole of North India. The University plans to collaborate with NGOs and other institutes to promote Information, Education and Communication (IEC) and Behavior Change Communication (BCC) outreach activities so that donated organs are readily available and each and every precious life can be saved.

The University furthers plans to enhance the ongoing transplantation program to make the transplant center an apex center not only in the state of Rajasthan but also at National and Global levels. Also, we plan to add DM and M.Ch programs in Organ Transplantation Anesthesia and Organ Transplantation Surgery respectively.

The University further plans to have collaborations with other pioneer institutes in the field of transplantation in India and abroad and to initiate students as well as faculty exchange as a faculty development program.

Annexure – 1

Annexure – 2

Best Practice – 2

1.Title of the Practice: Skill enhancement through Advanced and Basic Life Support training programs

2.Objectives of the Practice

MGUMST is committed for improving the care of patients in life threatening conditions in emergency room as-well as at the community level, in a field-based setting, through evidence-based skill training. The skill-based courses offered by the University proved to be educational programs with verified and intended set of standards imparting practical and outcome-oriented education. The significance of skill courses is highlighted by the fact that ATLS (Advanced Trauma Life Support) course is now mandatory to work as staff or faculty in surgical domains in majority of European Countries and the USA. Recently, National Medical Council has made skill Lab as essential requirement for all medical colleges. Propagation of Life support courses need to be emphasized at community level in order to deliver the first aid and resuscitative measures in the field setting and also to prevent sudden deaths.

3.The Context

As injury is precipitous and indiscriminate, the medical professional who first attends to the injured patient has the greatest opportunity which impact outcome. For doctors and other qualified healthcare providers and even lay man who faces emergency, ATLS, BLS, ACLS, ATCN and PALS courses and other hands- on training courses provide skills to develop an organized approach to:

Assess the patient's condition rapidly and accurately Resuscitate and stabilize the patient according to priority Determine if the patient's needs exceed a facility's capabilities Arrange appropriately for the patient's definitive care

Ensure that optimum care is provided

Skill courses are measurable, reproducible, and comprehensive system of advanced trauma care, advanced cardiac care, Basic Life Support. The Advanced Trauma Life Support course provides an easy-to- remember method for evaluating and treating the victim of a traumatic event with set standards.

4.The Practice

MGUMST organizes life support programs for various requirements and situations like trauma, hospital emergency, public places etc. as per the following protocols -

1. Planning for the course

2. Assigning the certified instructor

3. Announcement

4. Registration & Pretest.

5. Successful implementation

6. Post test

7. Award of Certificate.

Major areas covered are:

oIdentification of cardiac arrest and intervention.

oChoking

oUse of Automated External Defibrillator

oIdentification of Need in Trauma , Drowning, Heart attack and other emergencies

oRespiratory and Cardiac emergencies – Identification and Management

oTeam work and co-ordination in a high pressure setting.

oCoping with death.

oCardiac and nursing advance hands on training on simulators and mannequin.

COURSES, INSTRUCTORS AND INFRASTRUCTURE

Our centre has organized 29 ATLS Provider and 7 Instructor courses which are the maximum for any Centre in state of Rajasthan. The University offers these internationally recognized courses with most of the trainers belonging to our Institute. As per the guidelines of our University, every postgraduate student shall attend mandatory advanced skill course before appearing in examinations. We have organized more than 100 BLS courses and now planning to organize 6-7 courses per year. We have conducted mass basic life support courses for police personnel and students. Nursing college has organized 3 ATCN courses for nursing staff and students.

MGUMST has a state-of-the Skill Development and Simulation Lab spread over 850 square meters and is equipped with latest mannequins from Laderal® and simulators including a Virtual Anatomy Dissection Table from Anatomage ®.

ASSOCIATION WITH PRESTIGIOUS RECOGNISED BODIES

ATLS course is updated regularly by prestigious organization of American College of Surgeons. BLS and PALS course are certified by Indian Academy of Pediatrics (IAP). Some of BLS courses are from American Heart Association (AHA) and Anesthesia society.

We are nodal centre for ATLS course of American College of Surgeons (ACS) program to improve quality in trauma, cancer and overall surgical care. The knowledge and skills taught in the course are easily adapted to all venues for the care of patients. This course teaches medical core content in an interactive format. This program provides systemic and concise training for the early care of trauma patients. There are Hands-on skills sessions in simulated trauma settings. If a participant successfully completes this certified course his / her certificate status is valid for 4 years from course date. ATLS course is applicable in both large urban centers and small rural emergency departments.

We have conducted skill courses onCadaversfor Musculo-skeletal intervention and ENT endoscopic surgeries. University has round the clock value added skill courses and activities including Neonatal brain ultrasonography, central line insertions, hands-on endoscopic surgeries, critical care workshops and pediatric dialysis, gastro intervention and many more hands on trainings .

5.Evidence of Success:

Successful training is also offered to participants from other states like Jammu & Kashmir, Gujarat, Telangana, Punjab, Maharashtra, Karnataka, Haryana and MP. ATLS course is quite popular amongst

Health professionals from UK, Sri Lanka, UAE, Vietnam, Oman, Bangladesh and Nepal. More than 1300 participants including health professionals have successfully completed these skill courses.Success of these coursesis recognized by-

Better care in triage and emergency department.

Code blue team is working effectively in institution with protocol-based approach. Standards for successful completion are now established.

Health professionals from outside India are preferring our Institute for training.

Number of patients and beds in ICUs have been increased in the last 3 years and state government official had recognized the effective intensive care of Covid patients.

Permission for New courses in Emergency and trauma medicine has been granted.

Mahatma Gandhi Hospital is having its own faculty as instructor to manage the prestigious courses. Our centre has been chosen as IAP BLS course nodal centre from 2021 to organize BLS courses.

Our centre is main nodal centre for ATLS course.

6.Problems encountered & Resources required

There is an enormous need for development of the above emergency skills amongst the general population and healthcare professionals. To successfully address this need is a challenge and requires:

1. More trainers and course providers

2. More centers on and off hospital premises.

3. More frequent courses

These problems can only be addressed by conducting more training-of-trainers’ programs and creating awareness.

7.Notes

Tenth edition of ATLS student course manual is updated in 2018 with enhanced educational content and visual presentation. This course is reevaluated every 4 years by the American College of Surgeons Committee on Trauma and verification is done by VRC (verification review and consultation). ATLS program has changed and will continue to change as advances occur in medicine and the needs and expectation of society changes.

Annexure – 1

Annexure – 2

7.2.1 Details with Photos