New Delhi: At a time when most Western countries rely overwhelmingly on cadaver donors for liver transplants, India has charted a different path- Living donor liver transplants. This shift was at the centre of discussions at the annual conference of the Liver Transplantation Society of India (LTSICON 2025), held in the capital from November 20 to 23, where experts said the model has helped India emerge as the world’s leading hub for living donor liver transplants.
“This has been possible because Indian culture places a strong value on family and collective responsibility. The idea of giving is woven into our traditions, reflected in the story of Maharishi Dadhichi, who gave up his own body to ‘Indra’, who could create the Vajrayudha to protect humanity.”
According to data from the Global Observatory on Organ Donation and Transplantation (GODT) and the National Organ and Tissue Transplant Organization (NOTTO), India performed around 5,000 liver transplants in 2024. The country has more than 200 active liver transplant centres across the country.
Prof. Mohamed Rela, President of ILDLT, said that exceptional surgical skill with a moral and legal framework that ensures safety for both donor and recipient. “The Indian model of living donor liver transplantation has become a gold standard for the world. As India continues to lead through innovation and collaboration, we will keep sharing our experiences to enhance global outcomes and make liver transplantation accessible and safe for all,” Rela said. “ A liver transplant in India costs only a fraction of what it does in Western nations — yet outcomes remain comparable, and often better,” Dr Rela added.
As the conference opened, LTSI president Dr. Sanjiv Saigal framed India’s rise as a long, difficult, and deliberate transformation. He said the evolution of liver transplantation in the country reflects “India’s medical maturity,” noting that in just two decades, the nation has moved from a handful of transplant centres to more than 200 world-class units delivering high-precision surgery and strong outcomes. According to him, the collaboration between Indian teams and international bodies has helped set new benchmarks in technique, ethics and patient safety.
How journey begins
The journey was earmarked by Dr. A Soin and M Rajeskhar at the Apollo hospital, New Delhi in 1998. Around four decades ago, in 1988, it was estimated that about 200 000 people were dying from liver failure every year in India with no hope of survival. At the same time, there were 60,000 liver transplants being done every year in the USA and Europe, with an 80 percent success rate and 70 percent of 5-year survival. Moreover, the trade in human organs in India was widespread and legal, consisting mainly of kidney ‘donation’ from the poor to the rich via exploitative middlemen.
“The very rich Indians went abroad for liver transplants, where they often had to wait around 6 months for a deceased donor organ when there was no local recipient, and the liver they received was often of a marginal quality,” experts revealed. The middle class and the poor were left with no option because no therapy could substitute for the liver.
It was around this time, in 1989, when then Prime Minister Rajiv Gandhi returned from an overseas trip and questioned why India lacked the capacity to perform liver and heart transplants. His query pushed the Health Ministry to examine the gap. Several clinicians and policymakers then began an extensive push to introduce liver transplantation into India through public education, conferences and outreach to political leadership.
As transplant activity expanded, strong systems were gradually put in place to ensure transparency and safety. Every LDLT now undergoes several layers of medical, psychological and ethical scrutiny. Dr. Abhideep Chaudhary, President-Elect of LTSI, said this ecosystem works because of “rigorous protocols, a transparent donor evaluation system, and multidisciplinary teams who treat every case like family.” He added that India’s strength lies in the values that guide the process: compassion, accountability and clinical excellence.
LTSICON 2025 mirrors this approach, bringing together more than a thousand specialists from over 20 countries for scientific exchange and training. Dr. Charles Panackel, Secretary of LTSI, said the progress India has made is “not the achievement of a few individuals but a united national effort built on shared knowledge and ethical practice.” With over 700 members, he said the community has grown stronger through constant learning and openness, which remain central to improving patient outcomes and maintaining global leadership in LDLT.
Infrastructure
Until May 2007, 22 centres in India were registered for liver transplants, and at least 14 of them had done at least one. During this time, 346 liver transplants took place in India, with 250 from live donors and 96 from deceased donors. There were only four centres that performed transplants in double digits — Sir Ganga Ram Hospital, New Delhi (140), Indraprastha Apollo, New Delhi (102), Global Hospital, Hyderabad (28) and SGPGIMS, Lucknow (14).
The year-wise number of liver transplants done from 2009 to 2022 has almost doubled every four years. Presently, 183 centres are registered for liver transplants, excluding those registered only for retrieval. Tamil Nadu has the highest number (42), followed by Maharashtra (36), Karnataka (25), and Kerala and Delhi (11 each).
Eleven states, most in the northeast, do not have a liver transplant centre. Fifteen states have fewer than ten centres. The largest number of transplants are done in the Delhi NCR region (1548) and in southern India (Tamil Nadu, Telangana, Kerala, Karnataka) with 1626. Maharashtra and Gujarat together completed 606.
India now has around 500 liver transplant surgeons, with the top 10 having each performed more than 1000 transplants and gaining international recognition.
In 2022, India ranked third globally with 3920 transplants, behind the USA (9528) and China (6053). But it remains the global leader in living donor liver transplants (3183), ahead of Turkey, Korea, China and the USA.
The share of deceased donor transplants increased from 11 percent in 2009 to 18.8 percent in 2022. Several centres report overall adult survival rates of up to 95 percent, with one-year survival in adults at 84.3 percent and 95 percent in children. These match some of the best outcomes globally. Only two donor deaths have been acknowledged.
Challenges
In 2019, 95 percent of liver transplants were done in 175 private hospitals, while only 5 percent took place in five public hospitals. The picture remained largely the same in 2022, with only 101 transplants done in the public sector out of 3069.
Gender imbalance persists. Only 22 percent of women receive organs from men, while 68 percent of women donate to men. The mean age of recipients was 44.2 years for men and 43.6 years for women.
The journey to establish liver transplantation in India was slowed by a lack of legislation on brain death, the widespread legal kidney trade, shortage of trained professionals and high procedural costs. Over time, awareness campaigns, legal reforms and medical collaborations helped remove many of these barriers.
While India performed 3920 procedures in 2022, becoming the world’s third most prolific liver transplant nation and the top performer in living donor procedures, challenges remain. They include high surgical costs, a shortage of brain-dead donors, gender disparities, a dominant private sector, undisclosed complications and corruption-linked practices such as referral kickbacks.
Still, the impact of liver transplantation on Indian healthcare has been significant. Thousands of patients, especially from the middle class, have survived terminal liver disease because of these services. The field has also strengthened surgery, anaesthesia, hepatology, transfusion medicine and pathology in India. Experts at LTSICON said that while challenges persist, the progress made so far shows that solutions are achievable.
