Question 1

How can we be confident that a patient we refer will actually get a matching organ once they reach India?

Dr. Biswarup Purkayastha · Accepted Answer

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.

Question 2

What is the actual median waiting period once a foreign patient is listed?

Dr. Biswarup Purkayastha · Accepted Answer

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

Question 3

How many days does LVAD admission and workup actually take?

Dr. Biswarup Purkayastha · Accepted Answer

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.

Question 4

What are the financial and logistical implications of staying in India while waiting for a transplant?

Dr. Biswarup Purkayastha · Accepted Answer

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.

Question 5

What does the heart transplant surgery itself cost a foreign national, given the added legal requirements?

Dr. Biswarup Purkayastha · Accepted Answer

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.

Question 6

What factors would disqualify a patient from LVAD candidacy, so we can screen locally and avoid sending someone to India who won't qualify?

Dr. Biswarup Purkayastha · Accepted Answer

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.

Question 7

Given that Indian law prioritises Indian citizens for organs, how does that affect a foreign national's chances?

Dr. Biswarup Purkayastha · Accepted Answer

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.

Question 8

A heart transplant candidate is already medically complex, and the wait can run to a year. How do patients get through that uncertainty if their condition worsens?

Dr. Biswarup Purkayastha · Accepted Answer

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.

Masterclass on Heart Transplant in India for Foreign Nationals

Questions Doctors Asked Dr. Biswarup Purkayastha