It’s a hectic weekday for N.N. Mehra in his office at Mumbai’s hip business hub of Nariman Point as he juggles calls, gives a quick tip on a stock price and signs various papers. His after-hours schedule includes socialising at the club and catching up on movies. The fact that Mr. Mehra is 84 is almost a footnote given his active life. It wasn’t always so — there was a point in time, a period he calls “the dullest two years of my life”, when he had lost his appetite and felt enervated. That’s when he underwent a liver transplant in Delhi five years ago and turned the clock back.
Mr. Mehra is one of the many so-called “high-risk cases” — the legions of the elderly whose appetite for life, coupled with their financial well-being and increasing medical expertise, is leading them to undergo procedures such as liver transplants. “Age is no longer a contraindication. It is the patient’s physiological state, his cardiac, lung and renal condition that determine if he can undergo surgery,” says Dr. Viniyendra Pamecha, chief liver transplant surgeon at Institute of Liver & Biliary Sciences, Delhi.
Age is just a number Dr. Deepak Naphade, cardiovascular surgeon with P.D. Hinduja Hospital in Mumbai, found a key difference in patient perception in India when he returned from Australia 17 years ago. “A 60-year-old in Australia was considered young, but old in India,” he recalls. Much has changed. Minutes before speaking to The Hindu , Dr. Naphade had performed a bypass on a 77-year-old and the previous week a heart valve replacement on an 80-year-old.
“Lifespans have gone up, and apart from prolonging life, people are also looking at the quality of life,” says Dr. Hari Prasad, president of the Apollo Hospitals Group that has carried out an aortic valve procedure on an 85-year-old and a knee replacement surgery of a 100-plus patient.
Doctors say that the ability to tolerate surgical trauma is less among the elderly compared to younger people, but point out that the number of candles on the birthday cake is no longer the key determinant. “A 75-year-old can be very active. The performance status of a patient is graded in several ways such as the Karnofsky score (see box). For a major surgery, the performance status should be 60 or more,” says Dr. Arvinder Singh Soin, chairman of Institute of Liver Transplantation and Regenerative Medicine at Medanta Hospital in Delhi. Dr. Soin, who performed the liver transplant on Mr. Mehra, says until six years ago there were hardly any 60-plus cases. “With modern technology, patients who are high-risk are acceptable now,” he says.
Besides, the possibility of complications is much lower in centres that take up many cases or high-frequency centres, says Dr. Rajendra Badwe, director of the premier Tata Memorial Centre (TMC) in Mumbai. At TMC, patients aged beyond 60 were not operated upon a decade ago, but are taken up routinely now across specialities. “It is most important to run a team with focussed activity. Such a team has that much more experience to handle complications,” he adds. For this reason, TMC has 10 dedicated disease management groups.
Health-conscious generation Driving the trend is a better-planned generation of 70-year-olds. “Compared to the late 1990s, senior citizens now have better savings, many have medical insurance and they are aware of advances in medical technology. They know where services are being delivered,” says Sheelu Sreenivasan, chairperson of Dignity Foundation, which works with senior citizens.
Also, this generation is more health-conscious. “We do not differentiate between 40- and 65-year-olds. Longevity has improved and so has overall health,” says Dr. Manish Varma, head of the liver transplant department at Apollo, Hyderabad. “During organ retrievals of brain-dead people, we find organs of a 40-year-old often not as good as that of 70-year-olds,” he says.
Precautions There are precautions that need to be taken after surgery and continuing consultations with the doctor are a must. One also has to make requisite post-operation dietary and lifestyle changes. But it is worth the trouble. Mr. Mehra says he is leading a much better life after the transplant. His only complaint: “I miss scotch.”
roli.srivastava@thehindu.co.in
