An Icebox, a Live Heart and the Man Who Drove and Drove

In some ways, it was surprising that any good could ever come of a cadaver, a heart failure and a vehicle with a live heart in its trunk tearing through a crowded city.

That it did on June 16, 2014 in Chennai, and that more than 50 people coordinated the whole thing with surreal precision to save a life, could tempt one to use words like ‘miracle’ or ‘aberration’. But in truth, it was already the city’s eighth time this year: a heart transplant made possible by someone’s supreme generosity, a government organ registry’s bureaucratic brilliance and the police’s logistical enthusiasm.

A new heart to be put in a patient's cavity. Photo courtesy Dr Suresh Rao KG
A new heart to be put in a patient's cavity. Photo courtesy Dr Suresh Rao KG

The evening did not begin well. Kathir, the 30-year-old ambulance driver, was more anxious than he’d ever been on the job. At 6.30pm, he sat at the wheel in the porch of Chennai’s Rajiv Gandhi Government General Hospital, waiting for a live heart to be brought down in a box. He was supposed to drive it to a young woman who lay dying in the hospital he worked for, 12km from where he sat. The longer he took, the more dismal the chances of the woman’s survival. The Central Railway Station was just opposite him. Streams of pedestrians, autorickshaws, buses and cars were pouring in and out of the roads. Irritable honking filled his ears. He worried about the U-turns he would have to make around the unmoving traffic.

Kathir had driven ambulances for two years and was now with Fortis Malar Hospital. He did an average of four trips a day, but remembered few of them and even fewer of the patients he drove. The steel mesh that separated him from the chaos of paramedics, doctors and patient was as sacrosanct as the emotional barrier. He never asked who the patient on the stretcher at the back was, where she was from, or what was killing her. He tended to keep his focus on the road. The only way one could do “this ambulance job”, Kathir believed, was “with a blank mind”. It calmed his nerves.

Today, that usual composure eluded him. He was to transport not a patient but a live heart – just like the one quickening in his chest – still healthy, able to give life, unless he messed up. He knew that the heart had till recently belonged to a road accident victim who was now brain dead, and that without it, the young woman in Fortis would only survive a few more months. He was in charge of the yawning distance between the two places, the sliver between a second chance and death. He had transported a heart twice before and knew every second would count, everyone would be on edge until he delivered the organ to the doctors. A lot had to go absolutely right, much could go really wrong. His palms were sweating.

At precisely 6.39pm, a man rushed out of the hospital entrance clutching a blue icebox. In it, packed with perfusion fluid and ice, was the heart. Policemen held back the curious crowds craning their necks. Kathir started the engine.

Ambulance driving was the only job in which Kathir felt crucial, irreplaceable. When he dropped out of school in the sixth grade, his parents weren’t surprised – quitting was what all the boys in their slum tended to do. As an adolescent he tried job after job, careening towards ruin until he turned 18, old enough to get a driver’s license. After several dull years as a personal chauffeur, he applied for an ambulance driver position at MIOT Hospitals.

If you asked him, he would call it neither destiny nor choice but simply a thing that happened. He obtained a certification in basic life support methods and passed every emergency driving test there was. Having to be in control behind the wheel set his own life in order.

Dhanraj, the navigator, climbed into the ambulance next to Kathir. They had worked together many times in the past year. “The hand on my shoulder,” Kathir called Dhanraj, a 32-year-old psychology graduate and now second-level transplant coordinator. Dhanraj’s job today was to interact with the police deployed at every one of the 18 road junctions on the way to Fortis. He’d use their updates about blocks and diversions to direct Kathir onto the fastest route to the destination.

Dhanraj shouted in Tamil into his walkie-talkie, “We’re leaving the GH now!” On the other end, a policeman’s voice hissed. “Okay, we’re ready.”

Two surgical teams, the Fortis transplant coordinators, the government organ donor department, 29 policemen, and two sets of families knew the heart was now in motion. For each, the crux of the operation was different things – divine luck, medical precision, State efficiency. But to Kathir, it was about speed. He turned on the red beacon and the siren pierced through the air.

* * *

As Kathir drove out of the government hospital ‘IN’ gate cleared for him by the police, across the city at Fortis, 21-year-old Hvovi Minocherhomji was wheeled into the operation theatre. An hour earlier, Dr Suresh Rao, head of Critical Care, had anesthetized her and injected the first dose of immunosuppressant drugs. The prepping would prevent her body from rejecting the new heart – healthy but alien – straightaway. Her father Aspy Minocherhomji, or Captain Homji as he is known, sat outside the theatre in disbelief. Was this really happening? Should he dare hope?

Hvovi was a BCom graduate, an only child to a Parsi family from Mumbai. Since she was diagnosed with an enlarged heart four years earlier, her father, a merchant navy sailor, had quit his job to take care of her. Terms like ‘cardiomyopathy’ rolled off his tongue with unfortunate ease. Hvovi’s mother Amaity, a former banker, ran a franking business that was suffering neglect since the hospital visits had increased.

Hvovi’s heart was enlarged, sluggish and failing her. It was too weak to pump blood through her body. She couldn’t eat, breathe, stand, walk or even change her clothes without help. She rarely stepped out of her room or bed.

In May 2014, Hvovi’s Mumbai cardiologist Dr Brian Pinto declared that her condition was beyond artificial pacemakers or drugs. He gave her three months to live, unless her parents were ready to think about one final option: a heart transplant.

Capt Homji was stoic. “If this is the only way out or I lose my child, we don’t really have a choice but to do it,” he said. His wife excavated online material on the survival rates of patients with transplants, the cost and the procedure, but Capt Homji couldn’t bear to read it. With only one solution left for his daughter, he didn’t want to know the chances of failure.

If the Homjis wanted to proceed, however, they would have to leave Mumbai. In 1994, the central government passed the Transplantation of Human Organs Act, criminalizing commercial organ trade and legalizing transplants of all harvestable organs from donors after they were certified brain dead. There were a few acclaimed surgeries immediately after the legislation, but since then, Maharashtra hospitals have rarely performed heart transplants. Moreover, only 0.26 in a million people donate organs in the state.

In their research, the Homjis found that the UK and US had a stronger donor registry and a long history of doing heart transplants. But not only would it cost an alarming 500,000 GBP or 625,000 USD, they were told by the donor registries that the waiting period would be two years. Hvovi did not have that time.

At this juncture, Dr Pinto recommended that the Homjis meet Dr KR Balakrishnan at Fortis, Chennai. The family did not know then that Tamil Nadu had the highest organ donor rate in the country: 1.8 donors for every million (the lowest is Maharashtra, at 0.26 per million). Chennai was even better with 14 donors per million. By 2014, it had also performed ten times more organ transplants than any other state.

Dr KRB, as Capt Homji would end up calling his Chennai doctor, took Hvovi on. He informed them about another alternative: an LV assist device, a pump to the heart’s failed left ventricle. This could be imported immediately, but with the surgery would cost them Rs 60-80 lakh. Dr KRB, however, believed in a transplant, which he called “the gold standard”. It was the relatively more affordable option – approximately Rs 20-30 lakh including surgery, recuperation and ICU time – and Hvovi could have a normal, healthy life for around 15 years. On the flip side, she would have to be on immunosuppressants all her life – drugs that dulled her immunity enough to prevent her body from rejecting the transplanted heart. These would not only cost Rs 10,000 per month, but in the long term could also result in renal failure or malignant tumours. Infections could be common. Years after their transplants, Dr KRB’s patients called him even if they had a cough.

Chennai’s Route of the Heart: Crossing 12 kms in 13 minutes

Despite all its possible side effects, a transplant was the affordable and recommended option for Hvovi. The Homjis got their daughter listed in the Tamil Nadu waitlist for donor hearts. By late May, the family had moved to Chennai, renting an apartment close to the Fortis hospital.

Then began the horrid wait. Capt Homji likened it to the fear of the dark, of the unknown. Waiting periods for hearts ranged anywhere from a month to two years in the state. If he could count down to a fixed date, he might have fared better. But as their daughter’s health got worse – she was unable pass urine, she was barely awake and breathed through a ventilator in the intensive care unit – and she inched towards death, the family became increasingly frustrated. As they prayed harder, they recognised the morbid nature of their hope. “There is such guilt. Someone else has to die for his or her heart to be available for my child,” Capt Homji said. He told himself it was a cosmic balancing act.

On June 16, when he went for a morning walk – he was pacing the antiseptic white hospital corridors – Dr KRB called him. “A donor heart might be available for Hvovi today,” he said. Tamil Nadu’s centralized database of donors and waiting recipients, in which Fortis and Hvovi were registered, showed that the Chennai government hospital had declared someone brain dead the previous night. His family had consented to donate all usable organs in his body. Fortis sent a surgical team to run several tests on the donor. His weight and height had to match 80 percent. The age needed to be reasonably compatible. Capt Homji remembered the doctor’s tone as “cautiously optimistic”. The three-week wait had been harrowing, but he knew that it had been a relatively short wait, a rare stroke of luck.

By afternoon, the team in the government hospital sent a WhatsApp message to Dr KRB with a video of the cardiogram. In it, the young man’s heart was pulsing perfectly. A match was confirmed.

By evening, the heart was harvested, meaning it was surgically removed and preserved. Capt Homji was excited but still on edge. His daughter seemed relieved that the wait had ended, but she did not say much. In bringing the heart to Hvovi, transplanting it into her, and waiting for her body to accept it, a million things could go wrong.

The name Hvovi in Farsi means a swift wind, an unstoppable force. But that evening of the 16th, as she lay unconscious in the operation theatre, it was Kathir who embodied that predestined velocity.

* * *

The contrasting traffic at different points of the Green Corridor route taken by the ambulance
The contrasting traffic at different points of the Green Corridor route taken by the ambulance

As he turned around the circular Victory War Memorial at nearly 80kmph, Kathir was finally calm. He kept his foot pressed on the accelerator and eyes on the road. He shot across Napier Bridge over River Koovum and flew onto Kamarajar Promenade.

These arterial roads are some of the most congested in the city. Horns are always blaring and vehicles crawling forward. Motorists zigzag across lanes and cars overtake from all sides, creating complex, defeating knots that, once tightened, take hours to come loose. If Kathir got stuck in one of these, there would be no hope for Hvovi.

But on that evening, the road was clear. Vehicles stood to either side, giving the ambulance a central pathway. Kathir did not have to brake once.

Dhanraj’s call to the police when the ambulance left the government hospital had activated a Green Corridor – an open route without blocks or slow-moving traffic and where all traffic signals are green. This is done exclusively for medical emergencies.

Earlier that afternoon when the donor had been deemed a match, Fortis’ transplant coordinator had informed Chennai Commissioner of Police S George that a heart would be transported at approximately 6pm. George had called the nodal officer for green corridors, S Sivanandam, Deputy Commissioner for Traffic (Planning), who drew up the shortest route from the government hospital to Fortis. He swiftly mobilized a team of 26 police staff and assigned them to the 18 junctions on the planned route. An hour before they knew the heart would be harvested, these men fanned the route, assessing traffic and beginning to control flow.

As soon as the heart was in motion, the information was radioed to the police team who immediately blocked off feeder roads, switched the required signals to red, and diverted traffic to the side lanes. It was tough going; on Monday evenings in Chennai, this route spills over with beachgoers, office-goers, shoppers and people driving home. A pilot car with an experienced driver and an inspector from the Central Railway Station jurisdiction ran ahead of the ambulance, clearing the road.

Sivanandam had done this 30 times since 2012, when he became deputy commissioner for traffic. The first time, as he sat in the car following the dashing ambulance, his legs had quivered and his fingers felt cold. Six months ago, when he helped transport a child’s heart, he had overlooked two spots – a still-unblocked zebra crossing and a needlessly delaying U-turn – that he filed away in his mind as errors he must never repeat. Another time, they were held up as a parked private car had obstructed the hospital entry gate. Each operation was unique, with varying times, distances, drivers and interruptions.

This time, Sivanandam’s challenge was the road along Marina beach where pedestrians tended to amble across, and Greenways Road towards the end, winding and narrow, potentially slowing the ambulance down. But he had learnt from past mistakes, and prepared for virtually every possibility. The June 16 operation was his smoothest yet, but as he sat in the jeep that followed Kathir, he still felt as if his own heart was travelling at breakneck speed through the city streets.

As the heart in its blue box sped ahead, the usually cacophonic traffic radio frequency fell quiet. Only Sivanandam’s voice crackled occasionally, giving instructions. The inspectors he addressed would give short replies. Everyone felt united with a sense of purpose.

“They know they are saving a life,” Sivanandam explained later. “For men spending all their hours with thugs and lowlifes, what can be more exciting than that?” None of them – not the sub-inspectors ushering people in the hospitals, or Inspector Selvaraj navigating the pilot car, or his driver Balaji (or Head Constable 797 as he is called) – considered it a chore. They organized the green corridor as if they too had stakes in Hvovi’s survival.

As the Commissioner George put it, “People see the police force as hard and unapproachable. We badly need public goodwill. The green corridor wins us trust and affection.” It also seems to have instilled some sort of road discipline in Chennai drivers. On Kathir’s regular ambulance trips in the past year, he’s noticed the traffic now giving way when they hear a siren. Three-quarters of Chennai traffic is comprised of two-wheeler riders, and they tend to seal any available gap between vehicles; Kathir sees more of them moving aside. His old dread of ambulance-chasing drivers has almost disappeared.

That day, too, people turned their engines off, waiting patiently for 10 to 15 minutes at every junction, allowing the ambulance to pass without incident. Remarkable for a city that, since 2010, has topped the country in speeding and road accidents.

Kathir swooped past the 5km stretch of Marina Beach. Policemen stood every 200 meters, holding reflectors, preventing beach goers from darting across the road as they usually did. It felt like a VIP corridor. “In this case, the heart was the very important person,” Kathir would quip later.

He was at 100kmph now and almost past Santhome High Road. The speed made him think of his three-year-old son at home. Before he left for the government hospital, he had called his wife, a school librarian, to say he might have to work late. He had not said why. She would worry.

He entered the narrow Greenways Road, which had been emptied entirely. “Calm, be calm,” Dhanraj chanted, sensing Kathir tense up. Kathir continued to drive evenly, looking straight ahead. Later, when they each articulated what had motivated their speed and concern, they would use roughly the same words: “Someone has given her son’s heart. It should not go waste.”

* * *

The 4 stages of a heart transplant
The 4 stages of a heart transplant

That still-alive heart in the ambulance once belonged to R Loganathan, a 27-year-old man from Pazhayannur village of Kanchipuram district. He was a driver, like Kathir, and an only child, like Hvovi. Rajalakshmi, his mother, is a nurse in a Primary Health Centre (PHC) near their village.

Rajalakshmi was married off as a teenager, and had Loga (as she called him) when she was barely 15. When the child was one, her husband married a second time. Enraged, she stormed off, and since then had raised Loga alone. She likes to say they grew up together: when Loga was in kindergarten, she was studying in ninth grade. When he joined a diploma course in engineering, she was inspired to do one in nursing. He taught her to ride a bicycle. She gave him the initial P in his name, for Perumal, his father. In college, Loga replaced it with R, for Rajalakshmi. He nagged his mother to make this official at the gazette office, but she was always putting it off.

On June 12, 2014, as Loga waited on his motorbike to cross the highway at the mouth of his village, a cargo truck rammed into him and sped away. A shopkeeper, from whom Loga had purchased a new watch only minutes earlier, ran towards the rapidly growing pool of blood. Village residents called Loga’s mother and they rushed him to the Chengalpattu public hospital. Under-staffed and ill-equipped, the doctors there referred Rajalakshmi to a private facility in the Chennai suburb of Chromepet. To pay for treatment there, she sold her only gold chain. Neurosurgeons diagnosed that “his spine had split from the brain stem”. A nurse said there was “not even one percent chance” of Loga waking up.

That same night, Rajalakshmi carted her son’s unconscious body to the Rajiv Gandhi Government General Hospital, the biggest public health institution in Chennai. For three days, the doctors tried various drugs and treatments to normalize his blood pressure and revive him. Rajalakshmi, meanwhile, phoned the helpline Jesus Calls for a prayer. She sent her niece to the Parthasarathy temple for a coconut offering. She accepted a prayer braid from someone who looked like a Sufi saint outside the government hospital. But on the night of June 15, a team of doctors declared Loga brain dead.

As Rajalakshmi lay awake at 2am in the corridor outside Loga’s room, Prakash, a grief counsellor from the hospital, sat next to her. He explained what brain death meant, that all functions of Loga’s brain had permanently and irreversibly stopped, that although he looked alive, he was as good as dead. He had to come off the ventilator.

As a nurse herself, Rajalakshmi had noticed that Loga’s EEG was flat, which meant there was no electrical activity in his brain. She was aware that she had lost her son, but refused to acknowledge it. “Are they sure?” she asked. “What if they are wrong?” All night she watched different sets of doctors repeat tests on Loga every six hours. Every time, brain death was certified.

On the morning of June 16, Prakash saw Rajalakshmi gradually accept this. She looked often at her son’s placid face. She hugged him tight and cried. In tears, she told the gathered relatives one by one that her son was dead. Finally, when she went to speak to the doctors, Prakash asked gently if she was aware of organ donation.

Indian laws allow for only two kinds of donors: the patient’s near relatives for non-vital organs and brain dead persons. Since the legislation on transplants was passed in 1994, the rampant illegal and commercial organ trade in India has been curtailed to a great extent. However, the number of donations remains extremely low and, therefore, organs are still in short supply. India has only 0.26 donors per million people (Spain is highest at 35 per million, and the US is at 25 per million) and almost 90 percent patients in the waiting list die without getting an organ.

Even among the donated organs, only 28 percent of hearts turn out to be eligible for transplanting – lower than the impressive 84 percent compatibility of kidneys but better than the 17 percent of lungs that are good enough to transplant. A robust transplant program, thus, needs quite a large donor pool.

Relatives of brain dead persons are often unaware of the option of organ donation and are taken aback at the suggestion. They are enraged that it is brought up at a time of grief, afraid that it will disfigure the body of their loved one, or worried that it is religious taboo. They even suspect that the doctors will let their loved one die for the organs.

Rajalakshmi knew that none of these were real concerns. Almost as soon as Prakash mentioned donation, she consented. “Take everything you need,” she told him. “Let my son save five or six others. I don’t want his life to go waste.” In the PHC where she worked, a 2008 workshop had called such donations “the gift of life”. She wanted to donate not only Loga’s heart, but also his lungs, liver, cornea, kidneys and skin. They were all in good shape, she was told; she was proud to have raised such a healthy son. Some days later, back in her village home, Rajalakshmi would find an astrologer’s note made years ago, divining that Loga would live to his nineties. She cried, but prayed the prediction came true for those he lived on in.

Prakash takes great care not to rush mourning relatives into choosing organ donation, but as soon as they do, he acts fast – several fatally sick people wait years for hearts, livers, corneas and kidneys. Vital organs like the heart and lungs, once outside the body, are unusable after 4-6 hours and 7-8 hours respectively, and need to be delivered to waiting patients without delay. When Rajalakshmi signed the consent form for donation, Prakash sent an SMS to Dr Amalorpovananthan, the convenor of the Cadaver Transplant Programme.

Set up by the Tamil Nadu government in 2008, the Cadaver Programme – despite its macabre name – is the best organ-sharing network in the country. It was initially conceived to combat the notorious kidney trade rackets and now provides a legal, voluntary and ethical way to share organs in the state. It maintains a computerized central record of all donations and waitlists and allocates organs as soon they become available anywhere in the state. All hospitals that conduct donations and transplants register with the program and maintain a 24-hour transplant coordination committee. In Chennai, Apollo Hospitals, Madras Medical Mission, Frontier Lifeline, Fortis Malar and Vijaya Hospitals run some of the leading transplant facilities.

The transparent, rapid program in the state has seen 482 donations since 2008, enabling transplants of 2,642 organs, including 76 hearts. Dr. Amal says this is 10 times more than the national average.

Karnataka, Andhra Pradesh, Maharashtra, Gujarat and Delhi are the only other states to have set up cadaver registries. But without awareness drives, state support, internal coordination and collaboration with police, they have performed abysmally. After August 2012, when Union Minister Vilasrao Deshmukh died in Mumbai after doctors couldn’t find a liver to transplant in time, Maharashtra is attempting Tamil Nadu’s multi-pronged approach that integrates hospitals, State-run healthcare institutions, doctors, donors, the police and social workers.

Efficiency is crucial, of course, but an organ-sharing program’s backbone is donation. And there is no easy answer to why families in Tamil Nadu, in the darkest hour of their lives, volunteer to give the organs of their loved ones to other sick people.

Apollo Hospital’s Dr Paul Ramesh, who has done 15 heart transplants, thinks of organ donation as an “extreme altruism”. He suggests that local awareness in Tamil Nadu about donations – through state, private and media campaigns –plays a big role. “The more people see survival stories, the more it becomes a good deed,” he says. Donor families often know that donating an entire body helps at least 10 needy people. Donations are also surely encouraged by people’s trust in far-sighted, welfare-oriented governments that, while splurging on freebies like blenders and TVs for political mileage, also set up dependable public infrastructure.

Prakash says most brain dead donors are young people in road accidents, of which Chennai sees an alarming number. In his counselling sessions, he notices that families are often motivated by a need for meaning. “They want the sudden death and the wasted life to mean something. Many of them, in the final moment of decision, say, ‘Anyway, we are going to bury or burn this body, let it give life to someone.’”

For other donors, it is a way of slow mourning; the family is not ready to let go. “They search for some way to keep their loved one living on,” Dr Suresh Rao of Fortis says. Organ donation makes room for an illusory extension of life and helps the grieving negotiate with the idea of finality. Rajalakshmi says that her son may be dead, but “his soul can live on the earth”. For her, donation has been a way of spiritual closure.

* * *

Chennai saw at least three more such green corridor runs and heart transplants in just 10 days after Hvovi’s case. Doctors, ambulance drivers, police, and families have pulled off similar feats dozens of times since 2008, when the Cadaver Programme was established. Perhaps the most legendary donation in Tamil Nadu occurred the same year the registry was created:

a doctor couple donated their 15-year-old son Hithendran’s heart to a 9-year-old girl. In 2009, a 3-year-old’s heart found home in a 2-year-old, the youngest to receive a heart transplant in the country. Every organ donation and transplant in India is a true marvel, but the media highlights only some cases – drawn, perhaps, by the profile of the donor or patient, the speed, the medical difficulty, or simply the newsroom’s love for an inspiring story. A heart in a box, especially, sends journalists in a tizzy. In Hvovi’s and Loga’s case, it was perhaps also the clockwork precision visible on the roads. Dr Amal can never guess which cases will make headlines and doesn’t try to. “All media reports have dispelled myths and encouraged organ donation. It has saved so many dying patients.”

There remains the question of whether transplants – because of the expense – still largely benefit only the upper class in India. Dr Amal says this does not hold true for kidneys in Tamil Nadu, which are transplanted free of cost in government hospitals here. But he admits that even as the rate of donations is increasing, transplants are not catching up. Tamil Nadu has had 439 heart donors since 2008 but performed only 76 transplants. Few patients can afford it. Transplantation is costly, time-consuming and labour intensive for hospitals too, and only five do them routinely in Chennai.

For a good state transplant program, then, there is a long way to go. “The aim,” Dr Amal says, “is to reach a point where donations are widespread and dependable, and heart transplants can cost less. Ideally, they could be subsidized or even provided free for the poor. That’s who the state healthcare should eventually work for.”

When Dr Amal received the SMS about Rajalakshmi’s consent, his lean team of seven got to work straightaway. In their three-room office on the sixth floor of the government hospital, they scanned the state-wide online registry and identified the sickest, longest-waiting transplant patients for each organ. They informed the patients’ hospitals that the organ was available and the hospitals cross-matched Loga’s weight, height, age, and blood group with that of the respective patients. Once compatibility results came in, the heart and lung, which have the shortest lifespan outside a human body, were allocated first.

By the afternoon of June 16, only hours after Rajalakshmi’s generous consent, Loga’s heart was assigned to Hvovi. Soon after, the Fortis transplant coordinator called the police about the green corridor, and at 5.30pm, with everyone ready and waiting, Loga’s organs were removed. The blue box with the heart moved into Kathir’s ambulance.

* * *

The ambulance crossed the Adyar Bridge at 6.55pm. On cue, Dr KRB in the Fortis operating theatre opened up Hvovi’s chest. As he likes to say, “A big heart is only good in metaphors, not medicine.” He saw Hvovi’s enlarged heart visibly struggling. They put her on cardio-pulmonary bypass where a machine pumped blood for her and helped her breathe.

From the road, Sivanandam phoned the inspector stationed at Fortis. “Clear the areas around the gate and lobby!” he said. The media had got wind of the operation and swarmed all around the hospital. “Call the elevator down to the ground floor!”

The ambulance made the U-turn at Durgabai Deshmukh Road. The doctors were told of this and they heaved a sigh of relief and anticipation. In every transplant they had done, this had always been the penultimate moment. They removed Hvovi’s heart.

Kathir drove into the Fortis porch at 6.57pm. He had blown through a 45-minute route in 13 minutes. His shirt was drenched in sweat.

By the time Kathir got his breath back, the precious blue box had entered the operation theatre. Loga’s heart was placed gingerly inside Hvovi. In three hours, the heart would beat in her chest in a perfect lub-dub.

As he descended from the ambulance, cameras flashed and mikes were shoved in front of Kathir’s face. “How did you do it! How do you feel!” reporters asked him frantically.

Kathir truly panicked for the first time that day. “Can I please wash my face first?” he asked bashfully in Tamil. “I’m sweating.”

That night at home, his wife excitedly caught his interviews on all the Tamil channels. “I just did my job. I feel happy,” Kathir was saying everywhere.

Rohini Mohan is a Bangalore-based journalist who writes on human rights and politics. Her upcoming book, The Seasons of Trouble, a nonfiction account on postwar Sri Lanka, hits stands in October 2014. Tweet her @rohini_mohan and read her work here.

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