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Anita founded Metamagics in 2008 with an idea of solving some long pending problems in the computing industry. She zeroed down on problems surrounding complex and ad-hoc nature of data even before big data and data science became industry catch words. Metamagics has created a (patent pending) solution for data analytics. She has steered Metamagics from a deep R&D and technology company to launch two much appreciated products. GridSense is a platform for automated analytics. GridSense Health is a platform serving the entire organ transplant care ecosystem through its specialized offerings targeted at different stakeholders from patients to transplant centers to state agencies responsible for managing the organ donation and patient registry.
A personal encounter with liver transplantation led her to take a deep dive in healthcare and as a result she oriented Metamagics to create solutions for managing all aspects of organ transplant care, from the regulatory and compliance to patient care.
Anita holds a Masters in Economics from the Pune University and Computer Science from Punjab University.
ET: What is the current organ donation scenario in India and where does India stand in comparison to other developed countries?
AP: There is no single source of data on the status of organ donation in India. The number of deceased donations per million population is believed to be 0.8 persons. Within the country, there is great disparity; the southern states Tamil Nadu, Telangana, Kerala, Karnataka and Maharashtra account for 80% of the donations. Globally the rate of donation per million population is 26. Countries like Spain and Croatia have achieved a rate close to 40 per million population. The stellar success that states like Maharashtra has achieved is due to the drive undertaken by the institutions responsible for organ donations, increasing awareness among the people, working with the governments to break down infrastructure and policy barriers and creating a positive campaign. However, unlike the public perception about the drive for organ donations, what is really important is to create awareness about brain death.
ET: What are the challenges and concerns of donating organs and saving lives in India?
AP: Between brain death and a normal death there is a big question mark and not everyone can take that decision to convert a brain death to a death. It is an emotionally loaded decision. However relatives, parents and siblings and children are now making those difficult choices.
The biggest challenge is lack of awareness and information. It is important to spot the possibility of a brain death in an ICU and to move the patient in time to a hospital that is authorized for organ retrieval. Not all hospitals are authorized to retrieve organs. There are legal, ethical and human aspects to this. Given the length and breadth of the country, lack of fast transit, air taxis being so prohibitively expensive, ensuring timely movement of the organ at the required recipient location is a big challenge.
Recently, the courts in Maharashtra have ruled that any hospital could retrieve organs. However, it is still a question of accessibility. Organ retrieval is a highly specialized task and needs specialist retrieving teams. Transporting the organ from remote places to the transplant centers poses many challenges.
We do not even have reliable data on the total number of brain deaths in the country and then to zero down on the causes of why these could not be converted into successful organ donations is a big challenge. It is at the ICU, where a possible donor has lost the battle of life, that the donation efforts have to start.
Yet another big challenge is the lack of a nationwide real time network of information to spot a donor as well as a willing and ready recipient.
There is no nationwide registry of patients waiting for a new organ. An individual has to go and get registered from place to place in order to optimize the chances of getting an organ before it is too late. This makes it difficult to get accurate data on the recipient population. Even states where there are NGOs responsible for managing the deceased donation program, work from manual paper based systems, which is a major handicap in case of deceased donations as time is a critical success factor. An organ has a very short life of 5 to 8 hours once retrieved from the donor. There are many decisions to be made in that short window, allocating the organ to the most deserving and needy patient, ensuring the right tissue level match (HLA typing) and getting the recipient to reach the transplant center in time are all fraught with many challenges.
ET: What is the state of Organ transplant surgery in India? Do we offer the latest and best techniques or is it still preferable to go abroad for a transplant?
AP: We have a very thriving transplant program in this country with outcomes comparable with the best in the world. In fact in living liver transplants, India stands second only to Korea.
An organ transplant recipient is a patient for life and needs to be closely monitored for well-functioning of the organ as well as the side effects of the immune suppression which is mandatory for a transplant patient. It is therefore important to remain in close contact with the transplant surgeon even after the surgery is over and a patient is discharged. Hence, going abroad is not really necessary when you could get the best of the transplant surgeons here in India who have had the benefit of being part of globally recognized transplant schools and also have pioneered many best practices local to Indian situations. I can say this also from a personal experience as my husband underwent a liver transplant surgery in India three years back and we are grateful to the transplant ecosystem in India.
ET: Has technology helped in the way that stakeholders (especially doctors and patients) in the organ donation realm are connected? Please elaborate.
AP:
The transplant care in India (and world over) is arranged in a hub and spoke manner. The expertise and infrastructure required for an organ transplant is very sophisticated and expensive. Hence, transplant care is concentrated in a very few tertiary hospitals. Patients have to leave their home towns to get the transplant treatment.
While the technology adoption is quite well as far as the transplant surgery goes, the IT penetration in patient care is almost non-existent. Organ transplantation is an end stage intervention. So when the patient is referred for an organ transplant, a patient is already very ill for a long time, sometimes 3 to 4 years. The time patients spend on waiting lists is also very high, especially if there are no living donors. For kidney and liver, living donations is a possibility. For other organs such as lungs, heart, hands and pancreas, the patient is vulnerable to the chance of a deceased donor being available in time. The mortality on the waiting list is very high. Technology will go a long way in helping doctors better manage a patient on the waiting list. There are no automated systems for keeping track of a patient's health, short term complications, post-transplant recovery charts and long term outcomes is almost non-existent.
Also Artificial Intelligence (AI) and machine learning can play a big role here. Almost all patients listed for organ transplant do undergo frequent blood tests and other diagnostic investigations. If patient data is diligently tracked, it is possible to develop an early warning mechanism so that a patient can be mobilized well in time to a hospital or be moved closer to the transplant center.
Similarly, a transplanted patient needs lifelong care and serious medical attention. Patients have to follow a very structured regime of labs tests, exercise, diet and medication. As the patient goes home, the communication between the patient and the transplant center is through ad-hoc means such as e-mails, Whatsapp, phone calls and SMS. There is no well-defined and well governed platform for patient engagement anywhere in the country. A patient may suffer an adverse event related to, or maybe not related to the organ transplant, but the transplant surgeon needs to be aware of all that is happening to the patient. This is also to ensure that there are no new complications that may potentially be a cause of rejection of the newly implanted organ.
ET: Can you please tell us something about your company, Metamagics Computing, and the strides of the firm under your leadership?
AP: Metamagics is a software R&D company and we have created a unique (patent pending) platform for data analytics. This is known as GridSense (www.gridsense.in)
But more interestingly, what we have done is leveraged this data platform to create a platform dedicated for organ transplant care. Using our dynamic and semantic technology, we have been able to quickly configure a tailor-made solution for the needs of each organ specific transplant care. This platform www.gridsensehealth.com is the first of its kind in India and certainly very innovative compared to offerings elsewhere in the world in delivering transplant care on the web and using mobile apps.
We have created a very specialized HER/EMR for organ transplantation, however we have not stopped just there. We have evolved recovery signatures specific to the organ and ethology of the disease. We have automated the complex workflows to proactively deliver patient care. Most importantly, we have created a platform that ensures better adherence. The transplant process is a highly specialized healthcare delivery service and requires significant participation of the patient and a high level of participation of the patient's support group in completing the process. For every patient, living donor or organ recipient, it is important to be educated on the process and the expected outcomes. Using our app, the patient can stay on top of things and take better care of their condition. From pre-transplant decease progression to post transplant daily monitoring, all home generated data goes back into the transplant centers centralized repository, opening up the real possibility of applying machine learning and AI in transplant care.
Transplant surgeons are very highly trained doctors and there are far and few of them. For want of automated data systems they are forced to rely on their memory while attending to a patient. Human errors do occur and it is time that technology is put to use to assist the doctors.
Getting a new organ from a living donor or from a deceased donor is a landmark in a patient's life; technology should make it easy for the doctors and the patients to keep the organ in healthy condition and better manage long term side effects of post-transplant medication.
Metamagics has also taken lead in creating a solution for managing transplant patient registry. Using our digital platform coordinating agencies at state level, we are able to automate the entire listing and allocation process. Having the live data in the cloud now paves way to perform mortality on wait list analysis. As the state ministry has created a national (NOTTO) and region (ROTTO) level nodal agencies to better coordinate the organ transplantation in India, we believe that we are pioneering the culture of data driven insights which bring in transparency and responsiveness and a sense of urgency in the system.
We cater to the entire transplant ecosystem in India and are also now poised to take our solution global.
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