Multiorgan failure could occur in people belonging to any age group, and in no specific order, says Dr Suresh Raghavaiah.
Published Aug 30, 2024 | 7:00 AM ⚊ Updated Aug 30, 2024 | 7:00 AM
Dr Suresh Raghavaiah.
The human body is a marvel comprising multiple organ systems. The nervous system controls the brain, spinal cord, and all the nerves, The circulatory system consists of the heart and blood vessels, the respiratory system helps us breathe and exchange oxygen throughout the body, the digestive system is responsible for eating, absorbing nutrients, and excreting waste, the integumentary system includes the skin, hands, limbs, and other external body parts.
Each system has a different function and plays a role in keeping the individual healthy. When two or more of these organ systems—such as the brain and circulatory system, or the circulatory and respiratory systems—fail, it is generally referred to as multiorgan failure.
In an interview with South First, multiorgan transplant surgeon at Gleneagles BGS Hospital in Bengaluru, Dr Suresh Raghavaiah explains multiorgan failure, transplantation, and what the government could do to prevent casualties.
Edited excerpts from the interview:
Q: Is there an order in which organs fail in case of multiorgan failures?
A: No. The organ systems can fail in any random combinations, like the central nervous system can fail along with the circulatory system, or the circulatory system can fail with the respiratory system, respiratory system may fail with the excretory system.
The organs can fail in any permutation and combination. When more than two of them fail, we call them a multiorgan dysfunction syndrome. And generally, when more than two fail, they have a domino effect — one by one more system failures will follow, generally leading to death.
Q: Is there a particular age group more susceptible to multiorgan dysfunction?
A: No, it can happen to any age group. It can also occur in many permutations and combinations. However, the main cause needs to be found out.
Q: What is the primary cause of multiorgan dysfunction syndrome?
A: In the elderly, it is because of infection. For instance, if a patient is diabetic or hypertensive and his foot has become infected, his immunity will be low and care taken for his diabetic foot is less, the infection can suddenly spread all over the body. His kidneys may start to fail, his breathing gets affected, and his blood pressure drops. He will have the multiorgan dysfunction syndrome. So here infection becomes the precursor.
In younger people, let us say the patient has a major accident and has lost a lot of blood. Then, the brain does not get enough blood and so do the kidneys because the BP would be low. In such cases, he or she may develop central nervous system failure leading to kidney failure and multiorgan dysfunction syndrome. No age is exempted from developing multiorgan dysfunction syndrome.
Q: Is there any deadly combination of organ failures?
A: No. We consider organs that can recover and those that cannot recover. For instance, a mildly injured kidney can recover with dialysis. The liver has a remarkable ability to regenerate. If supported for five to seven days, it can recover. Similarly, treatments like angioplasty can help the heart recover after a heart attack. However, in the case of a severe stroke, the brain cannot regenerate, leading to poor outcomes.
As a multiorgan transplant surgeon, I often perform liver-kidney and kidney-pancreas transplants. The liver, like a vehicle’s engine, converts nutrients into energy. When it fails, energy production drops, impacting vital functions and leading to sequential organ failure, starting with the kidneys.
This results in high creatinine levels, fluid buildup, and eventually heart failure. Liver failure also weakens the immune system, increasing infection risks. Transplanting just the liver is complex, but when kidney failure is involved, the complexity and risk of complications increase significantly.
Q: What is the availability of organs for the transplant?
A: It is unfortunate that the demand for organs far outweighs the supply right now. We have huge waiting periods, even in Karnataka. I think there are more than 6,000 patients currently waiting for a kidney and about 800 people waiting for liver transplantations.
This is because knowledge about organ donation has still not permeated into our society very well. Although the government of Karnataka and the central government are taking a lot of steps, including the prime minister, who repeatedly talks about organ donation. It is commendable that he is spreading awareness. The knowledge about organ donation has increased.
However, the number of donations is still much less compared to the West. For example, compared with the US or Spain, our organ donation rates are 1/10th or even 1/100th of theirs. This is one of the primary reasons why people end up dying once they develop organ failure. Without a functioning liver, a patient might survive only between three to six months. If it’s only kidney failure, they can survive on dialysis, which is manageable.
But once the liver fails, they need a transplant to survive. This is one of the major roadblocks in saving patients who come with liver failure.
Q: Does metabolic health make any difference in preventing multiorgan failure?
A: Absolutely. Metabolic health plays a crucial role in preventing multiorgan failure. Many diseases we see today are due to poor metabolic health. From my 15 to 16 years of experience in liver transplants, I’ve observed a significant shift. Initially, about 50-60% of liver transplants were due to alcoholic liver disease and hepatitis B or C, with only 20-30% due to fatty liver disease.
However, in the past six to seven years, more than 50-60% of transplants are now due to fatty liver disease, a direct result of poor metabolic health.
This increase in metabolic liver disease is largely due to a lack of physical activity and poor dietary habits. People are consuming high-calorie, fatty foods while leading sedentary lifestyles. These extra calories are stored as fat, affecting the liver and leading to fatty liver disease, now termed Metabolic-Associated Steatotic Liver Disease (MASLD).
This condition can cause permanent liver damage, leading to the need for transplants. So, focusing on improving metabolic health is essential to prevent such outcomes.
Q: Can liver failure lead to multiorgan failure even without an infection?
A: Yes, liver failure can lead to multiorgan failure without an infection. The liver acts as the body’s powerhouse. When it fails, it disrupts the production of energy and absorption of nutrients, which in turn affects other organs.
The kidneys and heart can start to fail, skin may develop blisters, fluid accumulate, and changes in gut microbiota occur. Additionally, confusion and central nervous system issues can arise, and blood clotting can be impaired due to increased International Normalized Ratio — INR — and lesser platelets.
While infections can often lead to multi-organ failure, stress from any source can overwhelm the liver’s ability to cope, resulting in multiorgan failure.
Q: Are there any new technologies for preserving multiple organs for transplantation?
A: When we talk about organ donation, preservation is equally important. New technologies have emerged to help preserve multiple organs for longer periods.
In my experience over the past decade, we used to take organs from a cadaver, rinse them with a preservative solution, and store them in ice. For the liver, this method allowed us to preserve it for about eight to 10 hours before transplanting it. For kidneys, we get about 12 to 14 hours.
The introduction of pump technology marked the first major improvement. By connecting the organ to a pump that circulates a cold preservative solution, we could extend preservation time. This has now evolved to normothermic perfusion machines, where instead of using ice, we keep the organ in a machine that pumps oxygenated blood and nutrients.
This allows us to transplant organs, like the liver, up to 24, 36, or even 48 hours later. This technology provides a significant advantage, especially when the donor is far away, ensuring the organ is still viable upon arrival.
Q: Do you think government can play a role in treating multiorgan failure cases?
A: The involvement of the government is crucial in promoting organ donation and supporting multiorgan surgeries. Increasing awareness and providing facilities like dialysis centers can help reduce waiting times and improve patient outcomes.
While private hospitals currently play a more significant role in handling multiorgan dysfunction syndrome, the government is making encouraging strides in this area.
(Edited by Majnu Babu)
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