Featured ArticleIssueMarch 21

Build Through Wisdom

Dr Mohamed Rela, Chairman & Managing Director, Dr Rela Institute & Medical Centre, Chennai talks about setting up a world class centre for liver transplant

Not many of you would remember the injuries of Late Pramod Mahajan, the then BJP general secretary had just after he was shot. It was 2006, and Mahajan was battling for his life at Hinduja Hospital in Mumbai. An expert was called from King’s College Hospital, London to see if liver transplant was a possibility. At the time, there were very few liver transplant surgeons around the world, and Dr Mohamed Rela was one of them. Sadly, Mahajan died due to a cardiac arrest 13 days after he was shot. But it did bring liver transplant into the spotlight and the need for a dedicated programme in India.

Having seen the suffering of people with liver disease, Dr Rela left London to set-up a centre of excellence in liver transplant in India at Chennai, where he worked for the next 10 years. Later he worked on his pet-project with a vision of instituting a world-class liver care facility in India. Thus the Rela Institute and Medical Center was established and started service in 2018. Here he talks about his journey and what it takes to run the most advanced liver care centre in the world.

Early Life

Dr Rela comes from a business family based in the beautiful village of Tamil Nadu, Kiliyanur. He was born to SA. Shamsudin and Hasma Beevi in 1959. He remembers a happy childhood with two brothers and five sisters. Even as a kid, Dr Rela, wanted to be a surgeon whereas his classmates preferred careers in aviation, education or fine arts. He studied at The Besant Theosophical School, Chennai and passed with flying colours in 1974. Later, he joined The Stanley Medical College and secured MBBS from the University of Madras, 1982. He spent the next five to six years specialising in Hepatobiliary disease and moved to London, where he joined the King’s College Hospital in 1991. Here he got to enhance his skills in surgery and moved on to transplant medicine. It was during this time that he performed a liver transplant on a five-day-old girl with rare disorder called neo-natal aemochromatosis earnng him an entry into the Guinness Book of Records. Today, the girl is 20-years old and is living a full life.

Return to India

When Dr Rela moved to India, the field  of transplant medicine was in its nascent stage. “After working in the UK for over 20 years I moved to India in 2009 to help set up a liver transplant programme in my hometown, Chennai, a major city in South India. Until then liver transplant activity was primarily restricted to two centres in northern India,” Dr Rela shares. He set-up the liver transplant programme at Global Hospital, Chennai in November 2009 with a focus on both DDLT and LDLT.

Cadaver organ donation rates were just beginning to improve in southern India at that time. During his time at Global Hospitals Dr Rela worked to established liver transplant programmes within the Global Hospital group in Hyderabad (2009) and Mumbai (2014).

“Over the last six years, we have completed over 1500 liver transplants in Chennai alone, with over 270 of these being DDLT, and the programme has now become the largest single site liver transplant programme in southern India. The programme has also focussed on paediatric liver transplantation and innovative techniques in transplantation of small children and children with metabolic liver disease. Paediatric liver transplantation now constitutes over 30 per cent of our transplant volume and we currently perform over 50-60 paediatric liver transplants per year, making it one of the largest paediatric programmes in the world,” he shares.

Training Programme

With the liver transplant programme in place Dr Rela focussed on training and education. He has trained and mentored surgeons who have gone on to setup successful liver transplant programmes in India and neighbouring countries. The Chennai programme also developed India’s first university recognised postdoctoral fellowship programme for liver transplantation and liver surgery in 2012 and since then has been attracting Indian and international fellowship trainees. The fellowship programme has been expanded to include liver anaesthesia, critical care and paediatric hepatology.

“My team in Chennai is also involved in training and mentoring DDLT programmes in other hospitals within the state. We are currently supporting the DDLT programme in Government Stanley Hospital, where liver transplants are performed free of cost. There is also a plan to start a new liver transplant programme in government general hospital, Chennai in the near future,” Dr Rela shares.

The Next Step

“With a focus on a strong, dedicated and ethical concept of healthcare, I have now ventured into setting up a new healthcare facility named after me, Dr. Rela Institute and Medical Centre (RIMC),” shares Dr Rela. The new centre is a quaternary care hospital dedicated to fostering and responding to the needs of a diverse set of patients. The hospital is committed to being an international healthcare system with the state-of-the-art infrastructure facilities. The institute is designed to provide high-level care in all specialities with a special focus on care of critically ill and multi-organ transplantation. This hospital houses one of the world’s largest dedicated liver intensive care units. In addition to the quality quaternary care in all specialities, the hospital is committed to providing day-to-day ‘primary and secondary care’ to the local population with international standards. In a short span of 24 months, since its inception, over 450 liver transplantations have been performed. A plethora of firsts has been achieved, including successfully performing a liver transplantation on the youngest child in India of one month of age.

Key to Successful Centre

Talking about his experience and learning of setting-up successful transplant centre Dr Rela says that a number of factors impact success. Primarily a good surgeon leader, a modern facility and trained team along with time and perseverance lead to the success of any centre.

Leader with extensive transplant experience: First thing needed is to have leadership with extensive experience. A junior surgeon who has recently completed his training hoping to set up a successful transplant unit may not be successful. He has to mature as a leader before he can set up a world class service.

Setup or the facility for a transplant programme: In our country, it is possible in the public/govt. sector like in the central institutes where major investments are  possible.Unfortunately, this has not been widely adopted across the country. The private sector on the other hand has the potential to do so in India. When choosing a private-sector enterprise, it is imperative that the surgeon has some idea of its financial stability. The organisation itself should not be struggling with the finances and depend on the first instance of this budding transplant programme. This stability will allow for the setting up of long-term goals rather than short-term gains.

Well trained team: The third important aspect is to attract good staff who are either trained or are easily trainable in the various aspects of transplantation. In the beginning, it is always a bonus to have well trained professional to support the programme. This again comes back to opportunity and leadership which will attract these new staff to think and believe in this new programme to grow, learn and excel in the field.

Research: The clinical and research potentials come later, but are also key cogs in the wheel of a successful transplant unit. Again, with good leadership and results, the programme is bound to grow in size and stature. However, it is important to start as a small well-knit unit, and grow from there on.

Time and perseverance: Programmes can take up to five years to mature, and time should not be a metric to judge progress. It is also noteworthy that the financial affordability has tremendously improved in India, and the cost of LT is much lower than the west with equal if not better results and outcomes at the hands of our teams. These factors lay a fertile ground for any new transplant programme to bloom.

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