When to Refer: Recognising the Point of No Return in Heart Failure

Temporary VA-ECMO, or reassessing the patient for an LVAD, buys the time we need. The durability of these devices has changed the calculation: an LVAD that used to be a five-year solution five years ago is now good for a decade or more.

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.

Only about two in 25. Most referrals arrive already at 5 to 10% ejection fraction, a point reached only after a long decline, since nobody drops to a 5% ejection fraction over a fortnight unless it is acute viral myocarditis.

Modern drug therapy can delay heart failure for a decade, and a doctor can reasonably wait that long before a transplant conversation becomes urgent. What should not happen is a decade spent on medical therapy alone with no parallel conversation with a heart failure and transplant specialist.

No. He described himself as reachable through email, WhatsApp, Telegram, or the Jivo Healthcare platform, and framed responding to these queries as a professional duty rather than something he monetises.

A structured session, proposed during the masterclass, where a specific complex case with reports shared in advance is discussed live between the referring doctor, the patient, and Dr. Purkayastha, rather than a general query relayed secondhand.