less than 2 of liver transplants taking place in india happen in public institutions this has meant that liver transplants which cost rs 2030 lakh in most cases are available only to the rich this is not just an inequitable situation but an unsustainable one says a recently published paper reviewing the status of liver transplants in india the future of liver transplantation in india should move toward a more accountable equitable and accessible form we owe this to our citizens who have shown tremendous faith in us by volunteering to be living donors as well as consenting for deceased donation wrote gastroenterological surgeon dr sanjay nagral of jaslok hospital mumbai and two others who authored the paper published in the journal of clinical and experimental hepatology indias liver transplant programme might be flourishing but is marred by the lack of any mechanism for a registry or mandatory re porting of results too the paper pointed out it is estimated that around 1015 of patients undergoing live donor liver transplants ldlt in india are from abroad in some centres it is as high as 25 most are from the middle east or from pakistan sri lanka bangladesh and myanmar we are not aware of any other country where the proportion of ldlts for foreign patients is so high stated the paper it warned that other than regulatory issues such a difficulty in authenticating the paperwork and establishing relationship with donors excessive proliferation of ldlt for foreigners can potentially bring memories of the unfortunate period of organ trade that has haunted the history of transplantation in india in india 85 of liver transplants are from live donors the rules permit live donation from those who are not firstdegree relatives only with special permission from the state transplant authoritythough precise data is unavailable a substantial number of donors are family members beyond firstdegree relatives or even unrelated donors noted the paper cautioning that in the context of donor problems not being uncommon it could lead to a potentially hazardous situation