Heart Transplant in India for Foreign Nationals

Dr. Biswarup Purkayastha, Consultant in Heart and Lung Transplant and Vascular Surgery at Artemis Hospitals, Gurgaon, leads one of India's most active cross-border transplant teams. In a masterclass held on October 5, 2025 for Jivo Healthcare's partner doctors across Africa, he walked through what a heart transplant in India for a foreign national actually involves: how organs are allocated, how a heart failure patient is bridged through a wait that can run to a year, what it costs, and when a referring doctor should pick up the phone. This guide draws entirely on that session.

A team built around six centres and a hard problem

The Kims-Artemis heart and lung transplant programme is, in Dr. Purkayastha's own description, a relatively new unit in northern India, but the wider team behind it has completed around 660 transplants, more than 500 of them solid organs and over 60 LVAD implants, over the past seven years, operating across six centres: Kims Hospitals in Hyderabad, Artemis Hospitals in Delhi, KD Hospital in Ahmedabad, a centre in Mumbai, and Aster and Kims hospitals in Bangalore. It was the first team in the country to perform a breathing lung transplant procedure, and the first to use hypothermic oxygenated organ preservation, both advances that matter directly to a foreign national's odds of receiving a heart in time. The programme's services span heart transplant, lung transplant, combined heart-lung transplant, pan-India ECMO transfers, and ventricular assist devices used as a bridge to recovery, to decision, or to transplant.

The system foreign nationals must navigate

India's organ allocation runs through NOTTO, the National Organ and Tissue Transplant Organisation, and five regional bodies, called ROTOs, covering the north, south, east, west and northeast of the country. A foreign national is listed with NOTTO but becomes eligible for a specific organ only after every domestic hospital in the country has passed on it for size, blood group or tissue mismatch, a process that itself consumes six to seven hours and can compromise how usable the organ still is by the time it reaches them. There is one meaningful exception: an organ that becomes available inside the same hospital where a foreign patient is already admitted can be offered to that patient directly once the regional authority declines it, without waiting on a no-objection certificate from every other region in the country.

A treatment ladder, not a single decision

Heart failure moves through a defined progression before transplant becomes the answer: medical management until ejection fraction drops below 20%, then an implantable defibrillator, then, as symptoms worsen toward NYHA class 4, either temporary ECMO support or a ventricular assist device. Today's LVADs, led by the HeartMate 3, are magnetically levitated, weigh under 150 grams all in, and carry a far lower risk of clot formation than earlier generations. They serve three distinct roles: bridging a patient to transplant when a suitable organ is not yet available, bridging a very sick patient to candidacy by restoring end-organ function over four to five weeks, or serving as destination therapy in patients over 50 who are not transplant candidates, a role these devices now support for a decade or more.

Matching, cost, and the question of timing

Matching a foreign patient to a donor heart depends on blood group and body size as much as on availability. Even so, of the 20 to 25 foreign patients the team has transplanted over five to six years, all but two eventually received a heart, with the longest wait running 12 to 14 months. That wait carries a real cost: roughly $1,500 a month in hospital and medication expenses while listed, and a transplant package priced at $45,000 for the surgery plus $5,500 for the pre-transplant workup. Dr. Purkayastha's central message to referring doctors, though, is about timing rather than logistics: heart failure patients should be discussed at the start of that journey, when a right heart catheterisation and an LVAD are still real options, not at the end of it, when nothing but a transplant remains on the table.

The articles that follow take up each of these threads in turn: how India's allocation system works, how the LVAD treatment ladder functions in practice, what determines a match, what the journey costs, and how a referring doctor can tell early enough for it to matter.