Liver Transplantation in India: The Present and the future.(JAMA India - The Physicians Update, April 2001, Vol.4, NO.4) Orthopotic liver transplantation (OLT) is an accepted mode of treatment for end stage liver disease world over with five years survival rate approaching to nearly 85%. The procedure is now being developed and established in few centers across the country. Cost concerns apart, there is very little debate about the need for liver transplantation for adults and children in India. In fact, the rapid strides made in understanding the patho-biology and treatment of hepatitic viruses and hepatocellular cancer has expanded the indications for OLT. Now most patients who are condemned to die miserably with liver failure can be given a chance to live through OLT. The main bottle necks for future development of this field appears to be resistant among the medical professionals to accept the new modality of therapy, late referrals, low awareness of the general public, high cost of the procedure and poor availability of cadaver organs common to most developing nations. Developing of live donor liver transplant program is set to address at least the issue regarding the organ availability, which may in turn result in an exponential growth in OLT in India.

OLT has evolved over the last 35 years, and has now become established as the only and highly successful therapy for acute and chronic end-stage-liver disease. While it is performed routinely in the developed nations in nearly 300 centers, it is still in its infancy in the developing world.

In the West, approximately 2-3/million population pediatric liver transplants and over 6000 adult liver transplants are done annually.

A developing country like India needs its own programmes for two reasons. First, our patients even if accepted onto a foreign transplant programme will always be the last to be offered a liver and suitable livers are always in shortage. Second, the exorbitant cost of Rs.60-80 lakhs for a liver transplant in a western center can not be borne by most i India. A liver transplant can be performed at the cost of around Rs.20 lakhs, although this is beyond the reach of the majority of Indians, it might well be the only hope for some patients.

The author's centre at Delhi has carried out closed to 45 liver transplants and currently is the only ongoing successful liver transplant programme in India. There are few other hospitals where liver transplant had been attempted in India include Apollo hospital- Chennai, St.Johns Hospital - Bangalore, Jaslok Hospital - Mumbai and CMC Hospital - Vellore. The other hospitals which have attempted liver transplants in India include AIIMS, SGPGI (Lucknow) and SRMC and SMC hospitals (Chennai) and Sir Gangaram Hospitals (Delhi) etc. Major thrust to liver transplantation will only occur if both the patient and physician confidence in the procedure increases which is a catch 22 situation for most startup programs.