LVAD Candidacy Criteria: What Referring Doctors Should Test For Before Sending a Patient to India

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.

The single most important test is a right heart catheterisation. I want pulmonary vascular resistance under five Wood units, or at least reactive to pulmonary vasodilators, along with the transpulmonary gradient, the pulmonary arterial pressure index against body surface area, and the oxygen step up. Patients with intractable arrhythmias, or more than moderate tricuspid regurgitation with right heart failure symptoms like congestive hepatopathy, are not good candidates. But if the right heart is intact and the failure is confined to the left side from ischaemic disease, that patient is still a strong candidate for an LVAD.

The law is unambiguous that an available organ goes to an Indian citizen first. But there's a specific exception for in-house patients: if an organ becomes available at the same hospital where a foreign national is already admitted, and the regional transplant organisation refuses it or nobody from that region can retrieve it in time, that in-house patient, even if foreign, moves to the top of the list. The hospital only has to inform NOTTO directly, rather than waiting on a no-objection certificate from every regional organisation in the country, a process that can otherwise cost the hours that make an organ unusable.

A right heart catheterisation. What matters from that study is the transpulmonary gradient, the pulmonary arterial pressure index measured against body surface area, the oxygen step-up, and pulmonary vascular resistance under five Wood units, or at least demonstrably reactive to pulmonary vasodilators.

Intractable arrhythmias, and more than moderate tricuspid regurgitation accompanied by right heart failure symptoms such as congestive hepatopathy. Both point to a right side of the heart too compromised for a left-sided pump to solve the underlying problem.

Yes. A patient whose right heart function is intact, with failure confined to the left side from ischaemic disease, remains a strong LVAD candidate even without the more elaborate transplant workup.

So that a written opinion and consultation between the Indian specialist and the local doctor, customised to what needs to be tested in that specific country, happens before a decision to travel is made, rather than after a patient has already arrived and been found unsuitable.