The Status of Liver Transplantation in India

Background The passage of the Transplantation of Human Organs Act in 1994 banned the unethical trade in human kidneys and recognized heart beating brain death as a form of death. This enabled liver transplantation to be performed in India. We briefly recount the history of the Act's passage and describe, in some detail, the present status of the procedure. Methods We sent a questionnaire regarding liver transplant services via email to 400 members of the Liver Transplant Society of India requesting them to provide details on liver transplantation at their centres up to 2022. We received information on 3069 of 3920 transplants that had been performed in 2022. Results There were 183 registered centres who had performed a total of 3920 liver transplants, placing India in third position behind the USA (n=9528) and China (n=6053) while it performed the largest number of living donor liver transplants (n=3183) in the world. The most common indication for liver transplantation was non-alcoholic steatohepatitis (NASH)-related cirrhosis (20%). Our teams published 2449 PubMed indexed research papers and 384 foreign trainees came from 52 countries for training in liver transplantation. The concerns were the small numbers of deceased organ donation, the dominance of the private sector (96.7%), corruption in the form of kickbacks and false declarations of relationship and gender imbalance with only 22% women recipients receiving organs from men while 68% women donated their livers to men. Conclusion Liver transplantation has saved the lives of many Indians, made a major impact on Indian healthcare overall, and increased its reputation worldwide. There are problems which we hope will be tackled by increasing societal awareness.