The first successful liver transplant was performed on a 20-month-old child from Kancheepuram at Apollo Hospital in Delhi on November 15, 1998. This success laid the foundation for theestablishment of liver transplantation in India.
The journey
In the early years, only a select group of institutions took on the challenge of establishing liver transplant programmes. They invested heavily in infrastructure, built multidisciplinary teams, and trained specialists capable of managing every aspect of the transplant. Back then, the surgery involved large open incisions, prolonged hospitalstays, and reliance on imported immunosuppressant (anti-rejection) medicines that made the treatment prohibitively expensive for most families.
Over the years, however, steady progress has been made. From barely 100 procedures in 2005, the annual number of liver transplants in India exceeded 1,000 by 2012. By 2024, the country was performing roughly 4,500 transplants each year, one of the highest volumes in Asia.
Innovation and expertise
Behind this transformation lies a convergence of medical innovation, policy support, and growing clinical expertise. Outcomes have improved sharply as surgical techniques, post-operative care, and infection control practices have evolved. Indigenous production of essential immunosuppressive drugs has reduced dependence on imports, significantly lowering long-term costs.
The introduction of minimally invasive and robotic procedures has shortened hospital stays and enhanced recovery. Greater experience has allowed expansion to a range of liver transplants — ABO incompatible transplants (where the blood group of the donor and recipient does not match), combined liver-kidney transplants, multiorgan transplants, domino transplants, and auxiliary transplants.
Training programmes have produced a new generation of skilled professionals — adult hepatologists, paediatric hepatologists, surgeons, anaesthesiologists, and transplant nurses — who are taking transplant services beyond major metros to smaller cities. This decentralisation has made access to advanced care more equitable and strengthened the national transplant network.
Challenges remain
Despite this growth, liver transplantation remains complex and costly, calling for sustained policy attention. Greater coordination between State and Central authorities under the Transplantation of Human Organs Act (THOA) can help address key barriers such as donor availability and public awareness. India’s organ donation rate remains low compared to global averages, leaving a vast unmet need. The majority of liver transplants in India remain live donors, despite there being many potential deceased organ donors. The country needs to shift away from live donors to deceased donor transplants. Southern and western regions in India have led in deceased organ donations, and the rest of the country must follow.
The path ahead
Teaching and tertiary care centres are ideally positioned to become major contributors to deceased organ donation programmes. Efforts to integrate donor registration with existing national identity platforms — such as Aadhaar, voter IDs, or driving licenses — could simplify organ pledging and promote wider participation. Public awareness must go beyond one-time campaigns. Regular community education, coordinated hospital programmes, and the inclusion of organ donation topics in medical and nursing curricula can help change long-term attitudes toward donation.
While India’s transplant outcomes now compare favourably with global standards, we need to improve access. Expanding health insurance coverage — both public and private — to include the entire continuum of care, from evaluation to recovery, will ease the financial burden. Equally important is improving early referral systems. Many patients with end-stage liver disease are referred to transplant centres only after irreversible complications arise. Earlier referrals, guided by clear protocols and greater primary care awareness, can improve outcomes and reduce costs by avoiding late-stage interventions.
India’s liver transplant story is one of adaptation, collaboration, and resilience. In less than three decades, the country has moved from a handful of experimental attempts to a thriving ecosystem with global standard outcomes. What began as a rare, high-risk procedure is now a successful treatment option for thousands of patients each year.
The next phase of this journey must focus on scaling capacity, enhancing deceased donation, and ensuring greater financial inclusivity. As we celebrate 27 years of successful liver transplantation in India, we can draw inspiration from the first recipient. He is now pursuing a post-graduation in microbiology after completing his MBBS and recently became a father.
Today, a baby weighing as little as 3 kg can receive a successful liver transplant and that speaks volumes about the capability and skills of our transplant teams.
(Dr. Anupam Sibal is group medical director and senior consultant paediatric gastroenterologist and hepatologist at Apollo Hospitals Group. anupamsibal@apollohospitals.com)
Published – November 22, 2025 03:08 pm IST
