Are foreigners getting hearts before Indians?

In a bid to ensure that comparatively wealthier foreign patients aren’t getting hearts out of turn, the National Organ and Tissue Transplant Organisation (NOTTO) is seeking greater clarity from hospitals on cadaver hearts allocated to foreign nationals for transplantation.

While there are a set of robust rules that hospitals adhere to, members of NOTTO, who had a meeting in Delhi last week, held discussions on why an Indian patient may not be allocated the organ when it’s her rightful turn, and explored possible measures to remedy such practices. “We want to be sure that foreigners who are getting cadaver hearts are well within their turn,” Dr. Vimal Bhandari, director of NOTTO, told The Hindu.

“A major factor in heart transplants is affordability. We don’t want to leave any scope where hospitals play up the cost factor to discourage Indian patients from accepting the organs,” he said, adding that last week’s meeting brought together members from all the Regional Organ and Tissue Transplant Organisations (ROTTO).

The members discussed the need for hospitals to share all the details of the foreign patients on their waiting list, including the time of registration and a detailed explanation on why an Indian patient could not be a candidate for the organ.

Priority list

“As per protocol, Indian patients are always given first priority. Only when we don’t have an Indian patient, say, due to a blood group or weight mismatch, or in cases when the Indian candidate refuses the organ for some reason, a foreigner is given the opportunity,” said Dr. Suresh Rao, head of the Cardiac Critical Care and Cardiac Anesthesia at Fortis Malar Hospital, Chennai.

The hospital has carried out 184 heart transplants in the last few years, of which 53 were of foreign nationals. “At times, when the organ is available in a different city, the cost of the air ambulance goes up to ₹15-₹20 lakh. Stable Indian patients refuse to spend on an air ambulance. They think they will get the organ if they wait for a few more days. In such situations, foreigners get a chance,” Dr. Rao said, adding that the waiting list for foreigners (within a month of arrival) was 22%, and was 2% for Indian patients at their hospital.

Mumbai’s Fortis Hospital started the heart transplant programme in 2015. Since then two foreign nationals from Ukraine have undergone heart transplants. “As per the protocol, available organs are matched with recipients waitlisted with the Zonal Transplant Coordination Center (ZTCC), then with ROTTO, and finally with NOTTO. If there is no match with domestic recipients, the organ is offered to international recipients who are on the list,” explained Dr. S Narayani, zonal director of Fortis, Mumbai.