The Prometheus in All of Us

In Birmingham, at the Queen Elizabeth Hospital, Dr. Darius Mirza is one of the very few doctors responsible for the hospital’s record-breaking five thousand liver transplants. But it would be incorrect to say that his contribution to medical science, in the twenty five years that he spent in the west, is just limited to this achievement. To do so would undermine his efforts toward educating medical students, governments, and citizens in general about Hepatobiliary and Transplant Surgery.

His attendance at the Rotary meeting on Tuesday wasn’t a pit stop through his travels in India, as is the case with most of our foreign speakers. Dr. Darius Mirza has returned to home ground! He now fulfils a fulltime position as the Multi-Organ Transplant Lead for the Apollo Group of Hospitals. So we can certainly hope that he is able to keep offering his patients a chance at a new life. The way he plans on going about his duties, the obstacles he faces, and the support he seeks, formed the body of his speech.

“As a medical student, I was always very interested in the liver,” began Dr. Darius Mirza. Then, pointing to a sketch of Prometheus – one that shows him cast adrift, to be eaten by birds of prey – he attempted to dissect art. This was not done in a manner reserved for art critics, but in a way that suits a surgeon used to dissecting organs. He said, “The birds of prey would come and eat at his liver everyday, and the next morning the liver would have grown back. So [Prometheus] did not die out, even after being cast away to die.”

Thus, if you have ever heard the Greek tale, and were of the opinion that only Prometheus had a liver that grew back, you would be happy to know that “as much as two-thirds or three quarters of the liver can be removed to aid in curative surgery in advanced cases of cancer.” At the same time, our livers can be, and unfortunately often are, abused. Dr. Darius Mirza confirmed with utmost conviction that “forty of you here today have a fatty liver, and a significant proportion of you will develop a progressive disease due to that fatty liver.”

Yet there are stages of degeneration that a liver undergoes with time and abuse. Cirrhosis, a term we are of course all familiar with, is the direst stage. If a cirrhotic liver becomes cancerous, “you cannot remove half the liver because the liver would not be strong enough to cope with that.” The only other option is to replace the liver, a surgery that began over fifty years ago in the west, but is only a decade-old novelty in India. Unfortunately, the long list of patients, who have been advised a liver transplant surgery, succumb to their illnesses before a willing donor can be arranged for.

Still, it is the heartwarming success stories that will hopefully bring attention to those in need. “The smallest child we’ve operated on was two and a half kilograms. He was born premature, and was transplanted two weeks after being born.” The medical details of such a surgery bring us back to the “good friend of all surgeons,” Prometheus. Just as his liver grew back each time it was picked at by the “birds of prey,” the surgeon can remove the infected areas of a liver, or “take out parts (of the liver) from a brain-dead or living person, and transplant them.”

That said, it is important to note that “one out of every three living donors has the risk of dying.” Hence, the brain-dead donor is the better, but rarer option. These donors can offer “a heart, two lungs, pancreas, intestine, two eyes, skin, bones, and tissues.” For those in dire need, it might seem like running a grocery errand, but awareness has made the relatives of braindead patients yield to the distress call of those in need. “But the gap is huge.”

As of today, scientists have devised a machine that can store a liver outside of the human body. This machine is predicted to be a “game changer” in the coming years, as it makes it possible to recreate “what you have in the human body.” In many countries, doctors haven’t received a government allowance for using such an apparatus. The good news is that earlier this year, Dr. Darius Mirza’s plea to permit its use in India was granted, which legally allows him and his team of doctors to store a donated liver in “a way as safe as possible” until the need of a transplant does arise. So India is the first country, outside Europe and the United States, to get access to such machinery.

In conclusion, the speaker was proud to inform us that, in his opinion, the number of patients dying on the waiting list due to the lack of donors is reducing every year in India. However, according to him, by no means does this changing perspective suggest that we’ve reached our full potential.