Transplant Success, But Fewer Healthy Donors: Rising Liver Disease Signals Looming Crisis

As if the widening gap between liver recipients and donors was not alarming enough, doctors are now grappling with a new and more complex challenge: a steady rise in the number of people with unhealthy livers, further shrinking the already limited donor pool and threatening to deepen the crisis.

While liver transplantation in the country over the years has evolved into a highly successful, life-saving procedure with remarkable regenerative capabilities and increasingly accessible treatment—courtesy of advanced surgical techniques—the rising burden of liver diseases threatens to undo these gains.

“There is a rapid increase in the number of patients in need of transplants, while the availability of healthy donors is not keeping pace. If we do not have enough healthy livers, finding donors will become increasingly difficult,” Dr. Deepak Govil, Director, Gastroenterology Surgeon and GI Oncosurgery at Medanta Hospital, Noida, told The Health Outlook as he flagged a potential mismatch between demand and supply.

Dr. Vivek Tandon, Director of GI Surgery and GI Oncosurgery at the hospital, concurred with him, noting that donor availability is already emerging as a critical constraint. At the heart of this problem is the silent nature of liver disease. Specialists say most patients seek medical help only when the condition has advanced significantly. “The biggest challenge with liver disease is that it often progresses silently,” said Dr. Manish Kumar Tomar, Senior Consultant, Gastrosciences, Medanta Hospital, Noida. “By the time patients come to us, the condition may already be advanced.”

This asymptomatic phase—often referred to as the “silent window”—can last for years. During this period, conditions such as fatty liver, hepatitis, and early cirrhosis continue to worsen without obvious warning signs. Routine screening could detect these conditions early, but awareness and regular testing remain low.

Doctors point out that the profile of liver disease in India has undergone a major shift. It is no longer confined to alcohol-related damage. Instead, lifestyle-related factors—unhealthy diets, obesity, diabetes, physical inactivity, and stress—are driving a new wave of cases.

“We need to shift from reactive to preventive healthcare,” said Dr. Ajay Bhalla, Director, Gastrosciences at Medanta Hospital, Noida, emphasizing that waiting for symptoms is no longer a safe approach, particularly among people in their 30s and 40s.

“The key to prevention lies in adopting simple but consistent habits such as balanced nutrition, regular physical activity, maintaining a healthy weight, and limiting alcohol consumption—and if possible, avoiding it. Regular health checkups and screening tests can also help in early detection and timely management, significantly reducing complications,” said Dr. Bhalla.

The consequences of delayed detection become more severe in advanced conditions such as liver cancer. Dr. Tandon explained that most liver cancers are diagnosed late because early stages do not produce symptoms, making regular monitoring crucial for high-risk individuals. Chronic liver conditions such as hepatitis, fatty liver disease, and cirrhosis significantly increase cancer risk if left unmanaged.

Adding another layer of complexity is the expanding demographic footprint of the disease.

Data suggests that liver disease is no longer limited to specific groups. Cases among younger individuals are rising by 5–10% annually, while claims from Tier 2 and Tier 3 cities are increasing by 10–15% each year. A steady rise is also being observed among women, indicating a broader spread across the population.

Government estimates further underline the scale of the problem, with non-alcoholic fatty liver disease affecting between 9% and 32% of Indians—nearly one in three individuals.

Doctors attribute this to a combination of sedentary work patterns, including work-from-home routines, poor dietary habits, and environmental factors such as air pollution.

What is especially worrying, doctors say, is that the trend is now visible across age groups. While adults in their 20s to 50s form a large proportion of cases, similar patterns are increasingly being seen among children.

Dr. Govil said, “High intake of junk food, excessive screen time, and lack of physical activity are major contributors to severe liver conditions in children.”

Dr. Abhideep Chaudhary, President of the Liver Transplantation Society of India (LTSI) and Chairman and Head, Department of HPB and Liver Transplantation, BLK-Max Hospital, Delhi, attributed energy drink, alcohol, and high-sugar beverage consumption to the increase in young patients presenting with liver dysfunction. “Energy drinks, often perceived as harmless, contain high levels of caffeine, sugar, and chemical additives that place immense stress on the liver. When combined with alcohol or consumed excessively, they accelerate liver injury. Alcohol continues to be a leading cause of liver disease, and sugary drinks contribute to fatty liver disease. Together, these are creating a perfect storm, and the number of cases is steadily rising. If liver damage progresses beyond a certain point, a liver transplant often becomes the only life-saving option.”

Dr. Neerav Goyal, President-Elect of the Liver Transplantation Society of India (LTSI) and Head, Liver Transplant, Hepatobiliary and Pancreatic Surgery, Indraprastha Apollo Hospital, Delhi, concurred with Dr. Chaudhary, stating, “These drinks contribute to fat accumulation in the liver, inflammation, and long-term damage. Many young people are unaware of the risks and consider these beverages part of a normal lifestyle.”

Simple measures such as balanced diets, regular physical activity, adequate hydration, and periodic health check-ups can significantly reduce risk. Equally important is awareness—recognising that liver disease often develops silently and can affect even those who consider themselves healthy.