Staying Alive on the List: Bridging a Foreign Patient Through a Year-Long Wait

There's no absolute guarantee, but our programme gives a referred patient the best realistic odds in the country. My team has presence across the north through Artemis in Delhi, the south through Kims and Aster hospitals in Bangalore, and the west through KD Hospital in Ahmedabad and a Mumbai centre, which puts us in direct reach of three of India's five active regional transplant organisations. We're also the only team doing hypothermic oxygenated perfusion, which extends a donor heart's viable cold storage time from about four hours to eight to ten hours and widens the geography we can pull an organ from. Matching still depends heavily on the patient: blood group, a height in the 160 to 180 cm range, and a weight in the 70 to 90 kg range, because we can only accept a heart within about 10% of body surface area or 10 cm of height. The longest wait I've seen a foreign heart transplant patient go through is 12 to 14 months. Of the 20 to 25 foreign patients we've transplanted over the last five to six years, all but two eventually received a heart.

About a year, not more than that, once a foreign national is properly listed.

Roughly a week for the core workup. That includes a right heart catheterisation, with the numbers reviewed at a transplant or VAD meeting or heart failure clinic before we make a call. To meet regulatory requirements we also need a coronary angiogram and a CT scan of the chest, which sizes the device and the pocket it sits in.

A heart failure patient waiting here typically needs a hospital visit about once a fortnight, and hospital and medication expenses run close to $1,500 a month. Across a typical 12 to 14 month wait, that adds up to roughly $20,000 in pre-transplant costs, before the transplant itself.

Just under $50,000 in total. Our package for a foreign national is $45,000 for the transplant plus $5,500 for the pre-transplant workup.

Temporary VA-ECMO support or a reassessment for a full ventricular assist device is the standard response, rather than simply waiting for an organ to arrive in time.

An LVAD that used to be considered a five-year solution is now good for a decade or more, which materially changes how much risk a family and referring doctor need to accept during a long wait for an organ.

Roughly a week of structured workup: a right heart catheterisation, review at a transplant or VAD meeting or heart failure clinic, a coronary angiogram, and a CT scan of the chest to size the device and the surgical pocket it sits in.

Increasingly, yes. A patient on an LVAD who does not go on to receive a transplant is now considered an almost unusual outcome, because the device itself can sustain a patient for years.