Liver Transplantation in India: At the Crossroads

Abstract

As the liver transplant journey in India reaches substantial numbers and suggests quality technical expertise, it is time to dispassionately look at the big picture, identify problems, and consider corrective measures for the future. Several features characterize the current scenario. Although the proportion of deceased donor liver transplants is increasing, besides major regional imbalances, the activity is heavily loaded in favor of the private sector and live donor transplants. The high costs of the procedure, the poor participation of public hospitals, the lack of a national registry, and outcomes reporting are issues of concern. Organ sharing protocols currently based on chronology or institutional rotation need to move to a more justiciable severity-based system. Several measures can expand the deceased donor pool. The safety of the living donor continues to need close scrutiny and focus. Multiple medical challenges unique to the Indian situation are also being thrown up. Although many of the deficits demand state intervention and policy changes the transplant community needs to take notice and highlight them. The future of liver transplantation in India should move toward a more accountable, equitable, and accessible form. We owe this to our citizens who have shown tremendous faith in us by volunteering to be living donors as well as consenting for deceased donation.

Outcomes for high-risk hepatoblastoma in a resource-challenged setting

“…In India, living‐donor transplant remains the predominant form of liver transplantation, and most children with high‐risk hepatoblastoma are likely to be offered this treatment. Nevertheless, several factors have brought non‐transplant resections for these patients back into focus.…”

“…Although paediatric tumours are highly treatable, 80 per cent of children with malignancy die because they live in low‐income countries where access to medical care is often inadequate. Some of these countries, notably India, have launched cancer initiatives, concentrating treatment resources in regional cancer centres. Government initiatives, non‐governmental organizations and crowd funding have also provided financial support for the treatment of these children.…”

“…Government initiatives, non‐governmental organizations and crowd funding have also provided financial support for the treatment of these children. Tertiary paediatric liver transplant centres have achieved outcomes similar to those in Western centres, but there are few data on outcomes for hepatoblastoma, and none for high‐risk hepatoblastoma.…”

Heart transplantation in India—are we there yet?

“…Articles on transplantation have to be uploaded in the invasive cardiology section! Liver transplants, which started in India a good decade after heart, are now very commonplace and are being done in several centres across the country in large numbers [7]. They, of course, have the advantage of living donors.…”

Effect of Orthotopic Liver Transplantation on the Health-Related Quality of Life in Indian Patients with End-Stage Liver Disease: A Prospective Study

“…Currently, only about 2200 to 2500 liver transplants operations are being performed due to limited cadaveric donor pool 2,3 and the approved number of government recognized centers 4 .…”