Living Donor Liver Transplant is a Transparent Activity in India

Living donor liver transplant (LDLT) has progressed rapidly in India with at least two major centers performing over 200 transplants annually. There have been concerns regarding donor safety as donor deaths have been reported worldwide. In India, there is a possible underreporting of donor complications and mortality leading to the allegation that LDLT is a clandestine activity. Deceased donor liver transplantation activity may be less transparent as there are no national guidelines for retrieval and allocation of organs. LDLT is for a named person and as the activity can only be conducted in major hospitals with involvement of over 100 medical personnel in each operation, it cannot be a clandestine operation. Government regulations require licensing of hospitals following inspection by senior doctors and reporting of transplant activity periodically. About 2500 living donor liver transplants have been conducted in India and there have been 7 donor deaths reported in India. Rather than not being transparent, donor morbidity and mortality has received excessive media attention. Most liver transplant activity in India is well organized with clearance from hepatologists and anesthetists. Unrelated donation needs to be cleared from a State appointed Authorization Committee. Foreigners cannot be transplanted without State clearance and approval of the concerned embassy. The donor risk is discussed and the success of the recipient operation is also explained to all patients. The ever-increasing popularity of the operation in spite of the high cost and the requirement for donation from a family member suggests that many patients are living healthy life after transplantation. Overall LDLT is a transparent activity in India.