When Does Heart Failure Need a Transplant?

A transplant comes into the picture when the heart simply can’t keep up anymore, and nothing else has worked. We’re talking end-stage disease here. Symptoms even when the patient is sitting still. Medication, devices, earlier surgeries, all of it tried, none of it holding. At that point the cardiology team starts asking a different question: is this someone who can survive the operation, and recover from it?

According to Dr. Vishal Khullar, an experienced Cardiac Surgeon in Mumbai, Transplant isn’t the first answer. It’s the last one. By the time a patient gets there, every other route has been tried.

It’s not one person calling it. Several teams have to agree.

Cardiology referral: The treating cardiologist flags the patient. Usually when the medications stop holding, sometimes earlier if the trajectory’s clear.

Transplant assessment: A separate team tests heart function in detail, but also the kidneys, liver, lungs, infection status. They’re looking at whether the rest of the body can carry a new heart.

Psychosocial review: Honestly, this matters more than people expect. Adherence history. Family support at home. Whether the patient can manage immunosuppression for life.

Final listing: Only after everything clears does the name go on. A donor match then depends on blood group, body size, and how long the wait stretches.

Long process. Deliberately so, because in advanced heart failure the stakes don’t allow shortcuts.

Dr. Vishal Khullar is the Director of Cardiovascular and Thoracic Surgery, Heart & Lung Transplant at Fortis Hospital Mulund and Fortis S L Raheja Hospital, Mumbai. He’s spent over 30 years in the field, trained at Cleveland Clinic and Mayo Clinic in the USA, and performed thousands of cardiac procedures including high-volume bypass surgery.

His team gives patients an itemised estimate up front, with insurance coordination handled before admission. No vague figures, no last-minute surprises on the discharge bill.

1. NHLBI – Heart Treatments and Procedures
2. WHO – Cardiovascular Diseases