Liver transplantation in India

Abstract

Liver transplantation as an established form of treatment for end-stage liver disease has gained acceptance in India over the last 10 years. Liver transplantation in India has unique features that have contributed to the growth of both deceased donor and living donor transplantations of which living donor currently dominates the picture. Living donor contributes to 80% and deceased donor to 20% of the liver transplants currently performed in India. The majority of these transplants are performed within the private sector with public sector hospitals lagging behind significantly. This article gives an overview of the evolution of liver transplantation in India and the potential future challenges. History and Evolution of Liver Transplantation in India Success of Living Donor Liver Transplantation in IndiaThere has been a huge lag between the issuance of THOA in 1994 and the success and growth of DDLT. Patients who required LT had to travel to other countries, and this was feasible only for a small number of patients who could afford the cost of treatment abroad. Establishment of LDLT programs was a consequence of this lag in the growth of DDLT in the country. Even though LDLT involves highly specialized medical, surgical, and intensive care expertise and infrastructure, it can be achieved successfully by focusing resources and expertise in a single hospital. Two LDLT programs started in Delhi have grown very rapidly in the last 10 years with both centers having performed more than 1500 LTs. (5,6) Their success has paved the way for the confidence and growth of the technique in the rest of the country.

Drug‐induced acute liver failure in children and adults: Results of a single‐centre study of 128 patients

“…None of the patients underwent a liver transplantation although 6 patients were referred to a setting where this facility was available. The absence of liver transplantation is a limiting factor; paradoxically, the natural history could be observed. Unlike other developed countries, the limited availability of transplantation facility only in private hospitals, and its absence in most academic centres is unique to India and has been highlighted in a recent review …”

Long‐term health‐related quality of life in living liver donors: A south Asian experience

“…Key differences between our transplant program vs the West include our dependence on living donors (owing to low donation rates) while deceased donor liver transplantation (DDLT) is the mainstay in the Western countries . There is a lack of an integrated agency like United Network for Organ Sharing (UNOS) in India, which not only helps organ allocation but also collects follow‐up data on donors including complications . Deaths in patients with chronic liver disease (CLD) are much greater in the East, and the availability of transplant services are sporadic and far below demand …”

“…16 19 There is a lack of an integrated agency like United Network for Organ Sharing (UNOS) in India, which not only helps organ allocation but also collects follow-up data on donors including complications. 20,21 Deaths in patients with chronic liver disease (CLD) are much greater in the East, and the availability of transplant services are sporadic and far below demand. 22 Only close first-degree relatives are allowed to donate without special permission, and all other donors require clearance from an authorization committee, 18 while guidelines may not be as stringent for unrelated donors in the West.…”

Accessible pediatric liver transplantation in India: A long way to go

“…O ver the last decade, India has seen tremendous growth in the field of liver transplantation (LT) [1]. While pediatric LT constitute less than 10% of all transplant activity [2], extrapolating the data from the United States, its need in India is around 3000 precedures/year.…”