Liver transplantation in india: Access is improving, but can affordability keep pace with the growing demand?

Liver transplantation has been providing patients with a longer, healthier life over the years for those with advanced liver disease. As a doctor, however, I do not think we should just pay attention to the success of the surgery, but rather, I think we need to focus on the success of the surgical outcome. One of the most common worries is the cost of treatment, not only for patients and their families, but for years following the treatment and during the recovery.

Some complications can be treated with medicines once the liver has reached a stage where it can no longer carry out its vital functions but a medicine cannot always repair the damage. If this is the case, then the only definitive treatment can be a liver transplant. The problem is, when patients come through our door, they’ve typically endured months or years of suffering, which may have become a strain on their physical health, demands on their families and/or their finances.

The progress made in liver transplantation in India is encouraging. The nation has established special transplant facilities, skilled surgical teams, and capacity to handle complicated cases. India has scaled up to 3,920 liver transplants in 2022, as reported in a review published in the National Medical Journal of India. The same review named affordability and the low deceased organ donation rates, as well as the private sector dominance of transplant services, as challenges.

As a doctor, this brings a basic question to mind. In the case of a transplant, will a patient be able to receive timely treatment as well as receive the care necessary following a transplant?

Knowing the expenses associated with liver transplantation

Liver transplant is a complicated procedure that’s not just about the surgery. Prior to the surgery, we must determine if the patient is a good surgical candidate and if he or she will benefit from the surgery. This would include a thorough examination of the liver, kidneys, heart, infection susceptibility, and overall health.

Care must be taken in the evaluation of the donor, especially if a living donor. It is important that we make sure that donating a part of the liver is safe for the donor and that the liver is recovered enough.

The overall expenses will depend on what happens and the type of transplant, the hospital stay and if complications arise. The estimates of the transplant providers in India vary from around Rs 20 lakh up to Rs 45 lakh or higher. But, families should not expect this to be set because it might vary from case to case.

The hospital bill of a patient who recovers without major complications can be different from a patient who requires intensive care for a longer period, or who has to undergo more procedures or treatment for infection. These costs are related to the complexity of patient care and the cost-cutting approach should not compromise patient safety.

The problem is for families to plan for a significant sum of money, while their first priority is the patient’s life. Some will have insurance or savings and others will rely on loans, financial support or relatives to help. Thus, affordability may directly impact the speed of which a family can move forward with treatment.

The financial responsibility does not end with surgery

One point I particularly want patients to understand is that a successful transplant does not mean the patient no longer needs medical care. Transplantation replaces a failing liver, but it also introduces a lifelong responsibility to protect the new organ.

After surgery, patients need immunosuppressant medicines. These medicines reduce the activity of the immune system so that it does not attack the transplanted liver. They are essential, but they must be taken regularly and at the prescribed doses. Stopping them or changing the dose without medical advice can increase the risk of rejection, which means the body begins attacking the transplanted organ.

Patients also need regular consultations, blood tests and monitoring. We check liver function, adjust medicines and look for complications before they become serious. In some patients, infections, kidney problems, diabetes or high blood pressure may require additional treatment.

This is where affordability becomes particularly important. A family may manage to arrange money for the operation but struggle with the recurring costs of medicines, investigations and travel. If the patient lives far from the transplant centre, repeated hospital visits can add considerably to the financial burden. A family member may also need to take time off work to accompany the patient or provide care at home.

As doctors, we need to discuss these realities before surgery. Families should understand the expected follow up schedule, the need for lifelong medication and the possibility of additional expenses. Financial preparedness is not separate from medical care. It can affect whether a patient is able to follow the treatment plan consistently.

I think a thing that patients should understand is that a successful transplant does not equate to no medical care. Transplantation replaces a failed liver, but comes with a new responsibility for life to protect the new organ.

As physicians, it is our duty to have these conversations prior to surgery. Families should be aware of the follow up plan, lifelong medication and potential extra costs. Being financially ready is not unrelated to the medical. It can influence if a patient can stick to the treatment plan.

The concept of living and dead donor transplantation. Living and deceased donor transplantation.

India has an excellent programme of liver transplantation from living donors. Here, a healthy individual (usually family member) donates a part of his/her liver. The liver can regenerate and the remaining liver in the donor and the transplanted liver in the recipient can grow and recover.

But with living donation, there are two individuals who have to receive significant medical treatment – the donor and the recipient. Donor must be evaluated, operated on and followed up independently. Donation should always be given freely and be aware of the dangers. Never pressure a family member to donate because their medical need.

There is another way, called deceased donor transplantation. In this case, the liver is donated from someone who has passed away, and whose organs are donated following legal and medical protocols. Greater awareness and coordination among hospitals and transplant networks should enable a greater number of patients to have access to this option.

However, organ availability is still a problem. Not all patients are eligible for a living donor and deceased donor organs can be hard to come by. Improved public awareness about organ donation is thus needed but must be supplemented with a clear and ethical donation system.

Transplanting in an affordable way

Financial support should be considered by patients as early as possible, before the surgery is imminent. Depending on eligibility and availability, support from the government health schemes, the state programmes, a charitable organisation or hospital support may be available. Health insurance holders also should check in detail what is covered under their health insurance, such as donor related expenses, medicines, investigations and follow-up care.

I would advise families to get a clear detail of the probable expenses from the transplant team and comprehend what expenses might fall outside the preliminary bundle. Your hospital’s financial counsellor/social work team can provide information about what options are available. The costs following the discharge should also be discussed.

On a wider scale, a better system of hospital transplantation may enable more individuals to receive treatment without being forced to rely exclusively on costly private treatment. Transparent pricing and improvement of financial counselling would also assist families in their decision-making.

It is not safe to assume that a patient who can’t arrange the money will not receive treatment. The family may be trying to figure out how to afford a procedure and living expenses, as well as coping with the stress of a serious illness.

Looking beyond the operation

When we assess the success of a liver transplant, we look at survival, recovery, liver function, and the patient’s quality of life. However, these outcomes also depend on what happens after the patient leaves the hospital. Regular monitoring, access to medicines and timely treatment of complications are essential.

India has made significant advances in liver transplantation, and these achievements deserve recognition. However, the next step is to ensure that the benefits reach patients across different income groups. Improving surgical capacity must go hand in hand with better public sector access, financial assistance, ethical organ donation and long-term follow-up support.

Ultimately, a liver transplant should not be considered accessible simply because a hospital has the expertise to perform it. It becomes genuinely accessible when patients can receive timely treatment and afford the care needed to protect their new liver. As clinicians, our responsibility is not only to help patients reach transplantation safely but also to help them understand and prepare for the journey that follows.