DOCTOR GOOD GRAFT

Graft, or bribery, has been India’s bane. The graft that I am writing about is a boon to India’s suffering millions. It is called allograft, and its pioneer in India is Dr Astrid Lobo Gajiwala, the Head of the Tissue Bank at the Tata Memorial Hospital (TMH), Mumbai. Simply put, allograft is a process by which tissue from another human being is applied or implanted in the patient in need of it. This is different from an autograft, where the patient’s own bone or skin tissue is used.

The availability of autografts is limited. For example, in a child who is still growing, it would be clinically improper to take its own good bone tissue, to apply it somewhere else. Besides adding a surgical procedure, it is also traumatic for the child, and could even affect the future growth of its good bones. Similarly, if a patient has severe burns or ulcers, it would again be inadvisable to take some skin from the patient to apply it to the affected area.

On the other hand, some surgeons have experimented with biological tissues from pigs and cows (even heart valves), but they have a high degree of rejection by the human body’s immunological system. There are also religious inhibitions to such grafts. Synthetic tissues, or even metal prosthetics like hip or knee joints, are good to a degree. But they too degenerate through wear and tear, resulting in another replacement or replenishment.

Here is where Doctor Good Graft steps in, to literally stem the breach in the human anatomy – be it a gap in the bones caused by accident or infection, or covering large tracts of burnt skin.  A couple of months ago India Today, a leading weekly magazine, carried a story on Dr Astrid’s work. She was counted among the ten game changers of India; one whose work was dramatically changing peoples’ lives. Having read the story I decided to interview the game changer in her laboratory at TMH. This petite doctor (a Ph D in medicine) has an appetite for big things. She has transformed the lives of thousands of suffering patients through her research and its clinical applications. Going beyond borders, she was also the President of the Asia Pacific Association of Surgical Tissue Banks.

What is it about allografts that make them a game changer and a lifesaver? Autografts, synthetic or metal surgical implants (prosthetics) have their limitations; besides being painful, expensive and time consuming. The converse is true for allografts. They are cheap, quick and long lasting, as human tissue has the innate power to regenerate itself.

This raises two questions. From where does one get these allografts, and how safe are they? They are obtained from various sources – cadavers, amputated limbs or other surgical discards, within a particular time frame of death or surgery. Permission of the patient or next of kin is obtained for literally “recycling the body parts” as Dr Astrid observes with an infectious smile. Infection, ooh! That is eradicated by sterilization, radiation and other processes, to render the allografts completely safe for use on another person.

Bone tissue is a wonder worker for filling gaps in a bone after fracture, or holes caused by cysts, even in the jawbones. Dentists, infact, are among the major users of bone tissue. Since it regenerates naturally it serves as a platform or framework for natural bone to grow around it and thereby plug the gap. There are even cases of patients with bone cancer, who after an allograft, are walking again and living normal lives. 

Doctor Good Graft has another goodie in her kitty – amnion, another of nature’s wonders. The amniotic membrane is the inner lining of the sac that protects and envelops a baby while in its mother’s womb. After delivery or surgery it is either ejected or removed. This membrane is then clinically sterilized, processed and freeze dried. It is a gossamer-like membrane, like the wings of a dragonfly. In the case of severe burns, diabetic ulcers or bedsores it is not always possible to do a skin graft. But an amnion dressing can be easily applied. The beauty is that the surgeon can monitor the healing process because of the transparency of the membrane. He doesn’t have to apply or remove bandages that could even damage the delicately healing wound. And wonder of wonders, having done its work the amnion just dries up and falls off naturally, like a snake’s skin. Nature’s wonders and scientific achievements never cease.

This amniotic tissue can also be used for healing of skin reactions caused by radiation in cancer treatment. Since it is paper thin it assumes the body’s contours, and is even used on that most delicate organ of the human body, the eye.

Yet the work of this great game changer is relatively unknown outside the scientific fraternity. Even the widely circulated India Today story did not fuel interest in this scientific advancement; despite its painless benefits, cheaper process and faster healing. Hence I felt the need to make this story better known.

Incidentally, Astrid’s husband, Dr Kalpesh Gajiwala is himself a renowned plastic surgeon in Mumbai. He too has pioneered the use of tissue from his wife’s bank! It is not an issue with this couple, as together they strive to make this world a better place through wholeness, healing and the alleviation of suffering.

A coin must have two sides to be legal tender. So too with this activist for gender. Besides being a topnotch scientist she is also a feminist theologian. Her resume of church related activities, and positions held in the Catholic Church, runs into several pages. As a writer she has also received awards from The Examiner (Mumbai) and The New Leader (Chennai). Interviewing Astrid at TMH, I was able to go beyond the gossamer membrane (to get under the skin, in investigative journalism parlance), from the scientist to the feminist!

Sharing her thoughts on several burning or contentious issues she said that she did not find any incompatibility between faith and science. The latter was still fathoming the human body in a voyage of discovery. But scientists should not try to play God. Science, by virtue of its immense potential, cannot be left unbridled. It must have a purpose, and a code of ethics. Today any form of research on human beings, and even animals for that matter, has to be approved by an ethics committee; just like an industrial project requires environmental clearance.

For Astrid her work was an expression of her deep Christian faith. It was improving the quality of peoples’ lives, a fulfillment of what Jesus envisaged, in his reply to John The Baptist: “Go back and tell John what you have seen and heard: the blind see again, the lame walk, those suffering from virulent skin diseases are cleansed” (Lk 7:22).

On being queried if scientists or theologians could determine the exact moment when human life begins, she admitted that it was a nebulous state, with no scientifically precise answer. Life and death still had many unanswered questions. Though science and faith are not contradictory, if they both strive for truth, there could still be nebulous grey areas of conflict, especially where the biological sciences are concerned.

Contraception and abortion are some such areas. Astrid’s attention was drawn to the Catholic Church’s Canon Law that states, “A person who actually procures an abortion incurs a latae sententiae ex-communication” (Can 1398), that is one “that is automatically incurred on committing an offence, without intervention of a judge”. The reply was fast and furious. “Men don’t understand motherhood or conception. They make moral exceptions to justify war, which is also the taking of life. This is because both the theologians and the Generals are men. They understand the business of war, but they don’t understand motherhood”. If there can be situational ethics for war, then why not for abortion? Though in principle one is against abortion, there could be exceptional or mitigating circumstances where culpability is limited, she said. A cogent argument. It is along the same lines that Astrid debunked the Church’s unilateral rejection of any form of artificial contraception, which she felt was a better option, than having to resort to abortion.

Since Astrid is on several Church bodies and advisory committees she was asked about her experience in them. Was the hierarchy willing to listen to the voice of the laity? She had mixed reactions. A lot depended on one’s personal approach. It was like tight rope walking. One had to keep one’s balance. “If the hierarchy perceivers you as an opponent they will ostracize you, but if you are seen as one working for the good of the church they will listen to you”, she opined. She herself has been part of a feminist collective working on women’s issues. They act as a support group to each other, and do have an impact on the church.

She disagreed with the common perception that only those “who tow the party line” get appointed to church bodies. Her own experience was that she had often asked uncomfortable questions, but she still got called. She has just worked on a redressal mechanism for sexual abuse by church personnel, and a code of conduct. It has been submitted to the Catholic Bishops’ Conference of India. It remains to be seen if the bishops heed the advice of their women appointees.

This, despite another common perception, that our bishops are far more comfortable interacting with women, rather than male lay leaders. At this point Astrid felt that this may be because the bishops perceive women as more servile and subservient. As for another contentious issue, the ordination of women, Astrid said that she had actually lost interest, especially because of how priesthood is lived today – more institutional than people oriented.

She felt that a woman’s priorities are different – be it family, birth, or life. Women have much to contribute to the church, because they are more person, or relationship oriented, not structured like men. “It is a challenge to be a Christian, and even more as a woman in the church. But women shall not be found wanting” she affirmed.

Visiting Doctor Good Graft at her Tissue Bank at TMH was an enlightening and fascinating experience. Dr Astrid Lobo Gajiwala, the scientist, or the feminist, is in a league of her own. Wonder if her Tissue Bank could clone some of her own tissue, for the rest of us mortals to bank on? Indeed graft, allograft, is a boon for the country’s suffering millions.

OCTOBER 2013