He specialised in Budapest, but he built his life’s work in Kalaburagi. Dr. Basavesh Patil on why he chose transplant for its finality, why one incompatible donor is never the end of the road, and why a diagnosis at a village clinic can matter more than a transplant.
“I didn’t choose transplant for its rarity. I chose it for its finality.”
For years, a kidney patient in northern Karnataka faced a cruel geography. The disease was local, but the cure lay in Bangalore or Hyderabad, at the end of long journeys and longer waits on dialysis.
Dr. Basavesh Patil, Consultant – Renal Transplant, Laparoscopic and General Surgeon at Chirayu Hospital, Kalaburagi, set out to change that with a simple, stubborn idea: the patient should not have to leave home to be treated. As lead renal transplant surgeon, he has been part of the team that started the first kidney transplant programme in the Hyderabad-Karnataka region.
His path there was deliberate. After his MBBS at S Nijalingappa Medical College, Bagalkot, and his MS in General Surgery at M R Medical College, Kalaburagi, he went to Budapest, Hungary, for a fellowship in solid organ transplant. A Fellow of the IAGES and an executive member of KSC-ASI, Karnataka, he has also conducted many medical camps, including surgical camps where patients were operated on at no cost, and he continues to serve patients in rural areas.
Rashmi M from Neo Science Hub sat down with him to trace the road from training to Kalaburagi. They discussed what Hungary’s deceased-donor system taught him about what can realistically be built here, how his team handles the moments when a transplant almost falls apart, and the small clinic he set up for below-poverty-line patients. His vision, in his own words, is to bring the best possible medical services to the needy, especially in tier-2 cities and villages.
1.Renal transplant is a subspecialty very few surgeons from this region ever pursue. What made you choose it over a more conventional surgical career?
I didn’t choose transplant for its rarity. I chose it for its finality. In general surgery, you treat a disease. In transplant, you return a life.
During my training, I saw young patients from Kalaburagi, Bidar and Yadgir who had spent years on dialysis, travelling to Bangalore or Hyderabad for care. The disease was here, but the surgeon was not. That gap pushed me.
And once you have watched a kidney turn pink and make urine on the table after months of anuria, you cannot go back to routine surgery. That moment is addictive.
2.You’ve now performed a significant number of kidney transplants as lead surgeon in this region. How has your technique or protocol evolved between your very first case and your most recent one?
In my first case as lead surgeon, the focus was simply not to fail: get the anastomosis right and keep the cold ischemia time low. Today, the focus is on refinement and standardization.
Technically, we have moved to a more precise Lich-Gregoir ureteric implantation with minimal dissection of the golden triangle, along with routine intra-operative Doppler. In protocol terms, we have moved from a reactive model to a checklist model. Everything at Chirayu, from donor workup to cardiac fitness to immunology, is now protocolled.
My first case took much longer. My recent cases are faster, but calmer. And the speed came from the team, not just from me.
3.Hungary runs on deceased-donor transplants; India runs almost entirely on living donors. What did that contrast teach you about what’s actually realistic to build in Kalaburagi?
Hungary taught me system discipline. There, transplant is a public system. Brain death declaration, organ retrieval and allocation are all streamlined because deceased donation is the norm. In India, transplant is family-driven and rests on living donation, because of gaps in awareness, trust and legal hurdles.
What I learned is that you cannot copy and paste Hungary into Kalaburagi. What is realistic here is a hybrid model. First, make living-donor transplant absolutely safe and affordable, so that families do not have to migrate. In parallel, slowly build deceased-donor awareness with ICU doctors, the IMA and Jeevasarthakathe.
“We cannot wait for the deceased-donor programme to mature before we start transplanting. Our patients won’t survive that wait.”
4. When a willing donor turns out to be a poor match, what’s your next step? Do you have access to a paired-kidney-exchange network, or does the patient’s journey end there?
The journey does not end there. That is the most important counselling I do. First, we explain why, whether it is ABO incompatibility or a positive crossmatch. Then we offer three options:
- An ABO-incompatible transplant with desensitization, if the centre has the experience
- A paired kidney exchange
- Staying on the waitlist for a deceased donor
At Chirayu, we are part of an informal paired-exchange network with hospitals in Karnataka and Maharashtra. If donor A is incompatible with recipient B, and donor B is incompatible with recipient A, we exchange. We also maintain a registry. So I tell families: one no does not mean never.
5.Has a transplant ever almost fallen through, through a donor backing out or a last-minute crossmatch failure, that you and your team managed to turn around?
Many times. One case stays with me. The donor was the patient’s wife, a young mother. The night before surgery, she had a panic attack and backed out, and the whole family collapsed.
We didn’t push. Together with the psychiatrist and the counsellor, we sat with her and gave her 24 hours away from the recipient’s family. She came back the next day and said, “I want to do it, but I was scared and no one asked if I was okay.” That transplant went ahead, and the patient is doing well two years on.
The lesson is that donors need counselling as much as recipients do. A last-minute crossmatch failure has also happened once. We converted it into a paired exchange within a week.
6. Every transplant surgeon eventually loses a graft, or a patient. How do you carry that, and how has it shaped the way you counsel new patients about risk?
You never forget the first loss. It humbles you permanently. I still remember the name and the date.
I carry it by conducting a full audit with my team. Was it surgical, immunological, infection or compliance? We document everything, and I personally meet the family.
It has completely shaped my counselling. I never promise 100% success now. I tell every new patient that transplant is the best form of renal replacement, but it is not a cure. It is a treatment, and it carries risks. We discuss graft loss, death, infection and recurrence in the patient’s own language.
“Informed consent is not a signature. It is a conversation.”
That honesty builds more trust than any promise could.
7.What made you decide to set up your own clinic in a remote area for below-poverty-line patients, rather than expanding your reach through camps alone?
Camps are good for screening, but they are one-day events. A patient with a stone, a hernia or early CKD needs follow-up, not just a diagnosis slip.
I am from this soil. I saw BPL patients taking loans of ₹30,000 to travel to the city for a ₹500 consultation. So we set up a small clinic where consultation is minimal and investigations are at cost.
“It is not charity. It is accessibility.”
If I can catch a CKD patient early there and prevent dialysis, that is a bigger service than performing a transplant later.
8. When a patient at that clinic turns out to need a transplant or major surgery beyond what it can offer, what’s the referral pathway? Do you personally follow their case through to Chirayu?
Yes, I follow it personally. The clinic is the first filter. If a patient needs major surgery or a transplant, they are not simply handed an address. My coordinator gives them a date, I speak to the Chirayu team before they arrive, and I make sure their BPL card and Ayushman Bharat documentation are checked, so the cost is clear from day one.
Many times, I operate on them myself at Chirayu. The patient sees the same face in the remote clinic and in the OT. That continuity removes fear.
9. Is there a procedure you still prefer doing open, despite the broader shift toward minimally invasive surgery, and why?
Yes. Although I am a laparoscopic surgeon, I still prefer open surgery for large, impacted staghorn calculi and for many post-transplant lymphoceles and transplant nephrectomies. In emergencies too, such as a ruptured kidney, trauma, or a transplant bleed at 2 AM, open is safer and faster.
“Laparoscopy is a tool, not a religion.”
The patient needs the best outcome, not the smallest scar. In a resource-limited setting, open surgery also reduces cost and dependence on equipment. But if patients opt for minimally invasive or robotic procedures in the near future, I intend to be among the first few to perform them.
10. Xenotransplantation, with pig kidneys engineered for human use, made global headlines recently. Do you see that as realistic for India within your working lifetime, or still decades away?
It is brilliant science, but for India it is still decades away from routine clinical reality. We have only just made living-donor transplant accessible in tier-2 cities like Kalaburagi. Our immediate challenges are not a lack of kidneys but a lack of awareness, late referrals, infection control and the cost of immunosuppression.
Xenotransplant will face huge immunological, ethical and cost barriers. Within my working lifetime, I see ABO-incompatible transplants, paired exchange and the deceased-donor programme growing strong in India. Xenotransplant will remain in trials and compassionate use for the next 15 to 20 years.
