How to Choose a Liver Transplant Surgeon and Team in India: A Hepatologist's Guide

In short: a liver transplant is done by a team, not by one surgeon. The transplant surgeon performs the operation, while a transplant hepatologist (a liver physician) decides whether a transplant is needed, prepares the patient, checks the donor's safety and looks after the new liver for life. When you compare centres in India, look at the whole team: its experience, its published results, donor safety, ICU support and long-term follow-up.

Dr. Hitendra K Garg is a Transplant Hepatologist at Indraprastha Apollo Hospitals, New Delhi, and a former Assistant Professor of Hepatology at the Institute of Liver & Biliary Sciences (ILBS). He is not a surgeon. His role is to evaluate patients with advanced liver disease, work with the transplant surgical team, and care for patients before and after the operation. This guide explains what he asks families to look for.

Who needs a liver transplant?

A transplant is considered when the liver has failed or is failing and other treatments can no longer control the disease. Common reasons include:

• Decompensated cirrhosis from alcohol, hepatitis B, hepatitis C or fatty liver disease (MASLD/NAFLD)
• Acute liver failure, for example from viral hepatitis or a drug reaction
• Acute-on-chronic liver failure (ACLF), a sudden worsening in someone who already has chronic liver disease
• Liver cancer (hepatocellular carcinoma) within the size and number limits used by transplant centres
• Bile duct diseases such as primary sclerosing cholangitis, and biliary atresia in children
• Inherited and metabolic liver diseases such as Wilson's disease

Warning signs that need urgent review by a liver specialist

• Increasing yellowness of the eyes or skin
• Swelling of the abdomen (ascites) or legs
• Vomiting blood or passing black stools
• Confusion, excessive sleepiness or personality change (hepatic encephalopathy)
• Repeated hospital admissions for liver problems

If any of these appear suddenly, go to a hospital emergency department.

Types of liver transplant in India

Living donor liver transplant (LDLT). Most liver transplants in India are living donor transplants. A healthy family member donates part of their liver. The donor's remaining liver and the transplanted part both regrow over the following weeks. Living donation in India is regulated under the Transplantation of Human Organs and Tissues Act, and each donation needs approval from the hospital or state authorisation committee.

Deceased donor liver transplant (DDLT). The liver comes from a person who has been declared brain-dead and whose family has agreed to organ donation. Patients are registered on a waiting list, and the wait depends on blood group and severity of illness.

Split liver transplant. One deceased donor liver is divided between two recipients, often an adult and a child.

Paediatric liver transplant. Transplants for children, most often for biliary atresia or metabolic disease, done by teams with paediatric experience.

What has changed in liver transplantation

• Living donation is the main route in India. Using part of a liver from a family member shortens the wait compared with relying on deceased donors alone. Donor safety assessment is now a separate, structured part of the work-up.
• Keyhole donor surgery at some centres. Laparoscopic and robotic donor operations use smaller incisions. Some teams offer them, and suitability depends on the donor's anatomy. The recipient operation is usually still open surgery.
• More objective timing. The MELD score, calculated from routine blood tests, helps teams judge how ill the liver is and when to place a patient on the list.
• Transplant for acute-on-chronic liver failure. Selected patients with ACLF can be considered for urgent transplant, so this condition needs rapid assessment.
• Tailored anti-rejection treatment. Medicines are adjusted over time to balance the risk of rejection against side effects such as infection, kidney injury and diabetes.

How to choose a liver transplant surgeon and team in India

Ask each centre the same questions so that you can compare them fairly:

• Volume: How many adult (or paediatric) liver transplants does the team do each year?
• Results: What are the centre's own one-year and five-year survival figures for recipients, and how do they track donor complications? Ask for the centre's data rather than national averages.
• Donor safety: Who evaluates the donor independently, and what happens if the donor is not suitable?
• The team: Is there a dedicated transplant hepatologist, transplant anaesthetist, liver ICU, interventional radiology and infection specialists?
• Cost: What does the package include (donor and recipient surgery, ICU stay, medicines, complications), and what is extra?
• Follow-up: Who will monitor blood tests and anti-rejection medicines after you return home, especially if you live outside Delhi or outside India?

The transplant journey, step by step

1. Evaluation. The hepatologist confirms that a transplant is needed and that the patient is fit for surgery. This includes blood tests, scans of the liver and blood vessels, heart and lung tests, a dental and infection check, and counselling for the patient and family. The MELD score, calculated from blood tests, helps measure how sick the liver is.

2. Donor work-up (for a living donor transplant). The donor has separate tests to make sure donation is safe for them and that the liver size and anatomy suit the recipient, followed by the legal approval process.

3. Surgery. The operation is done under general anaesthesia and usually takes many hours. In a living donor transplant, the donor and recipient operations run at the same time.

4. ICU and ward stay. The team monitors the new liver's function, bleeding, infection and kidney function.

5. Lifelong follow-up. Anti-rejection (immunosuppressive) medicines are taken for life. Blood tests are frequent in the first months and become less frequent over time. Vaccinations, infection precautions and avoiding alcohol protect the new liver.

About the author

Dr. Hitendra K Garg, MBBS, MD (Medicine), DM (Gastroenterology), is Senior Consultant Gastroenterologist, Hepatologist and Therapeutic Endoscopist, and Transplant Hepatologist, at Indraprastha Apollo Hospitals, New Delhi. From 2009 to 2013 he was Assistant Professor of Hepatology at the Institute of Liver & Biliary Sciences (ILBS), New Delhi. He is a co-author of the Asian Pacific Association for the Study of the Liver (APASL) consensus recommendations on acute-on-chronic liver failure (Hepatology International, 2009) and led a study on tenofovir in hepatitis B reactivation presenting as ACLF (Hepatology, 2011; doi:10.1002/hep.24109).

Related pages: liver transplant evaluation and liver disease care in Delhi.

Frequently Asked Questions (FAQs)

1. Is Dr. Hitendra K Garg a liver transplant surgeon?

No. Dr. Garg is a transplant hepatologist, a liver physician. He evaluates patients for transplant, works with the transplant surgical team at Indraprastha Apollo Hospitals and looks after patients before and after the operation.

2. What is the success rate of a liver transplant in India?

It depends on the patient's condition, the type of transplant and the centre. Ask each centre for its own one-year and five-year survival figures and its donor complication rates, rather than relying on national averages.

3. Who can become a living liver donor?

Usually a healthy adult family member with a compatible blood group and suitable liver size and anatomy. Age limits vary between centres. Every donor goes through medical tests and the legal approval process required in India.

4. How long does recovery take?

Most recipients stay in hospital for a few weeks and return to light daily activities over the next two to three months, with frequent blood tests in the first months. Anti-rejection medicines continue for life.

5. Can a transplant be avoided?

Sometimes. Treating the cause (for example stopping alcohol, or antiviral medicines for hepatitis B) and managing complications can stabilise the liver for a long time. A hepatologist can tell you whether a transplant is needed now or should be planned for later.