Chairman, Cardiac Sciences, Fortis Hospital, Noida
Part 5 of 8 in Transforming Cardiac Care: Advances in Diagnosis, Surgery and Management
Heart Failure and the Case for Heart Transplantation
December 1, 2024
Some hearts cannot be repaired with a smaller incision or a stent; they are simply too weak to function. Dr. Ajay Kaul, Chairman of Cardiac Sciences at Fortis Hospital, Noida, addressed this end of the spectrum directly during a Jivo Healthcare masterclass for doctors across Africa: when medical management for heart failure stops working, the only two remaining options are heart transplantation or an artificial heart.
When Medicines Are No Longer Enough
There is a wide range of medicines available for heart failure, and most patients are managed on them successfully for a time. But once those medicines stop controlling the patient's symptoms, according to Dr. Kaul, something more has to happen. For a patient with no remaining medical option, transplantation is still considered the best available treatment.
Transplant Outcomes Can Be Durable
Dr. Kaul pointed to one of his own earliest transplant patients, done around 12 years before this session, who is still alive, doing well, and now an athlete with a normal daily routine. It is a concrete answer to a common patient concern: transplant is not simply a way to extend life briefly, it can restore a genuinely normal one.
The Waiting List Is the Real Constraint
The practical obstacle to transplant is supply, not surgical capability. There is a long waiting list for donor hearts everywhere, and a patient can wait six months, eight months, or a year or more before a matching heart becomes available. That gap is exactly where an artificial heart device becomes relevant as a bridge, covered in the next article in this series.
What Happens to the Donor, and What Transplant Requires Afterward
A question that comes up often, and did in this session, is what happens to the donor. Dr. Kaul was direct: a heart donor is already deceased at the time of donation, so nothing further happens to them; it is not a living donation. For the recipient, transplantation is not a one-time event: any organ transplant recipient, whether of a liver, lung or heart, must remain on anti-rejection medication indefinitely. In India, that therapy costs on average about 25,000 to 35,000 rupees a month, ranging from roughly 20,000 to 50,000 depending on the regimen.
This guide is based on a live Jivo Masterclass: Dr. Ajay Kaul taught doctors across Africa on December 1, 2024.
FROM THE LIVE Q&A
Dr. Kamba
Following up on the complications of artificial heart transplantation, what about a further concern he described as 'autonomic surgery' in this context?
Dr. Ajay Kaul
Dr. Kaul reiterated the transplant complications he had already covered, then said that there was nothing called autonomic surgery that he was aware of, and that the term appeared to be a translation error. The exchange closed with a request for Dr. Kamba to put the question in writing in the chat so it could be understood correctly.
Frequently Asked Questions
Are there any techniques available for treating tetralogy of Fallot?▼
Tetralogy of Fallot is very well treatable, and children who are operated on go on to lead a normal life. I have patients who are now 25 to 30 years old and doing very well. Depending on the exact type of tetralogy, the results are very good.
How does an artificial heart actually work?▼
The heart is essentially a pump: blood comes in from the body, is pushed to the lungs to be purified, and is then pushed back out to the body. Building an artificial pump that does not damage or clot the blood took nearly 50 years to perfect. The device is based on magnetic levitation technology, similar to Japan's high-speed trains that run without touching the rails, so the pump's rotor never actually makes contact with the blood it is moving. In India, one artificial heart costs around 1.5 crore rupees, which is the major cost barrier.
Is heterozygous (mismatched donor-recipient) heart transplantation possible?▼
It is technically possible, but very few doctors would attempt it. A heart is a precious, scarce organ with a long waiting list of patients, so we always give it to the best-matching recipient rather than risk it in a less compatible match where rejection is more likely.
What happens to the donor in a heart transplant?▼
The donor is already dead by the time of donation. It is not a live donation, so nothing happens to the donor.
What can someone who is currently healthy do in everyday life to keep their heart healthy?▼
Some factors cannot be changed: genetics (a family history of coronary artery disease, hypertension or diabetes), age, and sex. Some factors are partially avoidable, like living in a polluted city or staying in a highly stressful job or relationship. The fully preventable factors are the most important: smoking or chewing tobacco has no offsetting benefit and damages the heart, lungs or mouth; alcohol should be limited to two or three drinks, two or three times a week; walking at least 10,000 steps a day and taking the stairs down instead of the lift helps; and the single best exercise is a 3-kilometer walk in 30 minutes, twice a day. On checkups: if there is a family history of heart disease or diabetes, get a cardiac checkup from age 20; if there is no family history, get one by age 40. And before starting any strenuous new exercise routine, such as joining a gym, get a cardiac checkup first, because the heart often gives no warning symptoms until it fails outright, the same way a car needs servicing even when it seems to be running fine.
What happens when medication no longer controls heart failure?▼
According to Dr. Kaul, the only remaining options at that point are heart transplantation or an artificial heart device.
How long can a patient wait for a donor heart?▼
The wait can range from around six months to a year or more, depending on donor availability.
Does a heart transplant recipient need ongoing medication?▼
Yes, indefinitely. Anti-rejection therapy in India costs on average about 25,000 to 35,000 rupees a month.
In This Series: Transforming Cardiac Care: Advances in Diagnosis, Surgery and Management
- 1.Transforming Cardiac Care
- 2.Minimally Invasive Cardiac Surgery: A New Standard for Heart Operations
- 3.Valve Replacement and Coronary Bypass Surgery Without a Full Sternotomy
- 4.Treating Aortic and Carotid Aneurysms With a Minimally Invasive Stent
- 5.Heart Failure and the Case for Heart Transplantation
- 6.The Artificial Heart (LVAD): A Bridge to Transplant
- 7.Tetralogy of Fallot and Eisenmenger Syndrome: Two Very Different Outcomes
- 8.A Cardiac Surgeon's Guide to Preventing Heart Disease