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Heart Transplant In India: Why Thousands Of Patients May Never Reach The Waiting List

For a patient with advanced <span><a href="https://www.healthandme.com/health/heart-failure">heart failure</a></span>, there comes a point when medicines, devices and repeated hospitalisations can no longer control the disease. For some, a <span>heart transplant</span> may offer the only realistic path to long-term survival. Yet in India, the challenge often begins much earlier than the waiting list: many patients who could potentially benefit from transplantation never reach an advanced heart-failure or transplant centre for evaluation. 

The scale of the problem is enormous. A recent study found that 83,000 heart transplantations were required annually in India in 2021, although only a very small proportion of that need was met. In comparison, according to the National Organ and Tissue Transplant Organisation (NOTTO), 221 heart transplants were performed in 2023. 

<h2>Why Patients With Advanced Heart Failure Miss Out </h2>

The first issue is delayed referral. Patients with advanced heart failure may continue to be treated repeatedly for breathlessness, fluid retention or hospital admissions without being assessed early for advanced therapies. 

A transplant evaluation is not a last-minute decision. It requires time to assess the patient's medical condition, other organs, infection risk, nutrition, psychosocial circumstances and ability to undergo lifelong follow-up. 

The second challenge is the limited availability of donor hearts. <a href="https://www.healthandme.com/health-wellness/surgeon-in-gurugram-patient-in-hyderabad-could-robotic-telesurgery-bring-specialists-to-smaller-cities-article-156271856" data-type="tilCustomLink">Heart transplantation</a> depends almost entirely on deceased organ donation. India has made substantial progress in transplantation overall, but the national deceased organ donation rate remains less than one donor per million population. 

<h2>How Geography And Cost Affect Access To Transplants </h2>

Geography and affordability also matter. Advanced heart-failure programmes and transplant centres are concentrated in selected regions, meaning that patients from smaller cities and rural areas may face substantial travel, financial and logistical barriers. 

The cost of evaluation, repeated hospitalisations, mechanical circulatory support and post-transplant medicines can further influence whether a patient can realistically pursue transplantation.

Also read: <a href="https://www.healthandme.com/health-wellness/youve-got-a-pigs-heart-genetically-modified-pigs-with-human-like-organs-transforming-organ-donation-details-inside-article-151255050" data-type="tilCustomLink">“You’ve Got A Pig’s Heart!” Genetically Modified Pigs with Human-like Organs Transforming Organ Donation; Details Inside</a> 

<h2>When Should Patients Be Referred To A Transplant Centre? </h2>

We therefore need to change the way advanced heart failure is recognised. A patient with recurrent hospitalisations, persistent symptoms despite optimal therapy, progressive kidney or liver dysfunction, low <a href="https://www.healthandme.com/fitness/hiit-and-high-blood-pressure-what-doctors-want-you-to-know-article-156344471" data-type="tilCustomLink">blood pressure</a> limiting medications, or dependence on intravenous therapies should trigger consideration of referral to an advanced heart-failure centre. 

Early referral gives specialists more time to evaluate the patient, assess treatment options and determine whether transplantation or another advanced therapy is appropriate.

World Heart Day: Doctors Answer Your Questions About Heart Health & Modern Lifestyle Habits

 <h2>Heart Transplant Is Not The Only Advanced Treatment </h2>

Importantly, transplantation is not the only advanced therapy. Left ventricular assist devices (LVADs) can serve as a bridge to transplantation or, in selected patients, as long-term therapy. 

These devices can help support the heart's pumping function in patients with advanced heart failure who meet the criteria for their use. The appropriate option depends on the patient's condition, overall health and treatment goals. 

India has demonstrated that transplantation can grow rapidly when infrastructure, coordination and public awareness improve. The next step is to ensure that patients are identified early enough to be evaluated, and that a shortage of donor organs does not remain the only reason they never get the opportunity to reach the transplant list. 

<strong><em>By Dr. Pravin Kulkarni, MBBS, MS (General Surgery), MCh (Cardiovascular and <span rel="noindex">Thoracic Surgery</span>), Fellowship in CTS, Director, <span rel="noindex">Advanced Cardiac Surgery</span> and Heart and Lung Transplant Program</em></strong>

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For a patient with advanced heart failure, there comes a point when medicines, devices and repeated hospitalisations can no longer control the disease. For some, a heart transplant may offer the only realistic path to long-term survival. Yet in India, the challenge often begins much earlier than the waiting list: many patients who could potentially benefit from transplantation never reach an advanced heart-failure or transplant centre for evaluation. The scale of the problem is enormous. A recent study found that 83,000 heart transplantations were required annually in India in 2021, although only a very small proportion of that need was met. In comparison, according to the National Organ and Tissue Transplant Organisation (NOTTO), 221 heart transplants were performed in 2023. Why Patients With Advanced Heart Failure Miss Out The first issue is delayed referral. Patients with advanced heart failure may continue to be treated repeatedly for breathlessness, fluid retention or hospital admissions without being assessed early for advanced therapies. A transplant evaluation is not a last-minute decision. It requires time to assess the patient's medical condition, other organs, infection risk, nutrition, psychosocial circumstances and ability to undergo lifelong follow-up. The second challenge is the limited availability of donor hearts. Heart transplantation depends almost entirely on deceased organ donation. India has made substantial progress in transplantation overall, but the national deceased organ donation rate remains less than one donor per million population. How Geography And Cost Affect Access To Transplants Geography and affordability also matter. Advanced heart-failure programmes and transplant centres are concentrated in selected regions, meaning that patients from smaller cities and rural areas may face substantial travel, financial and logistical barriers. The cost of evaluation, repeated hospitalisations, mechanical circulatory support and post-transplant medicines can further influence whether a patient can realistically pursue transplantation.Also read: “You’ve Got A Pig’s Heart!” Genetically Modified Pigs with Human-like Organs Transforming Organ Donation; Details Inside When Should Patients Be Referred To A Transplant Centre? We therefore need to change the way advanced heart failure is recognised. A patient with recurrent hospitalisations, persistent symptoms despite optimal therapy, progressive kidney or liver dysfunction, low blood pressure limiting medications, or dependence on intravenous therapies should trigger consideration of referral to an advanced heart-failure centre. Early referral gives specialists more time to evaluate the patient, assess treatment options and determine whether transplantation or another advanced therapy is appropriate.       Heart Transplant Is Not The Only Advanced Treatment Importantly, transplantation is not the only advanced therapy. Left ventricular assist devices (LVADs) can serve as a bridge to transplantation or, in selected patients, as long-term therapy. These devices can help support the heart's pumping function in patients with advanced heart failure who meet the criteria for their use. The appropriate option depends on the patient's condition, overall health and treatment goals. India has demonstrated that transplantation can grow rapidly when infrastructure, coordination and public awareness improve. The next step is to ensure that patients are identified early enough to be evaluated, and that a shortage of donor organs does not remain the only reason they never get the opportunity to reach the transplant list. By Dr. Pravin Kulkarni, MBBS, MS (General Surgery), MCh (Cardiovascular and Thoracic Surgery), Fellowship in CTS, Director, Advanced Cardiac Surgery and Heart and Lung Transplant Program

heart transplant in india: why thousands of patients may never reach the waiting list

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Heart Transplant In India: Why Thousands Of Patients May Never Reach The Waiting List

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Heart Transplant In India: Why Thousands Of Patients May Never Reach The Waiting List

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