Key points
- A deceased donor liver comes from a person certified brain-stem dead under the Transplantation of Human Organs and Tissues Act (THOTA); the family's consent is required.
- Patients are registered through a licensed transplant hospital on the state organ-sharing waiting list, which operates under the national network led by NOTTO.
- Allocation follows state rules — blood group, how sick the patient is and hospital rotation all play a part. No one can buy or jump the queue.
- When a liver is offered, the family must reach the hospital within hours, so the patient must stay reachable and ready at all times.
- Waiting is unpredictable. Many families keep a living donor option under discussion at the same time.
What is a deceased (cadaveric) donor liver transplant?
The diseased liver is removed completely and replaced with a whole liver (or, sometimes, part of one) from a donor who has died. In India almost all deceased organ donors are people who have suffered a catastrophic brain injury — often a road accident or a brain haemorrhage — and have been declared brain-stem dead while their heart is still beating on a ventilator. The liver keeps working only while blood is flowing, which is why organs are recovered in the operating theatre before the ventilator is switched off.
Brain-stem death is legal death in India. Under THOTA it must be certified by a board of doctors, with tests performed twice, none of whom may be part of the transplant team. Only after that, and only with the written consent of the family, can organs be donated.
| Deceased donor transplant | Living donor transplant | |
|---|---|---|
| Source of liver | Brain-stem dead donor, family consent | Healthy relative gives part of their liver |
| Timing | Unpredictable; depends on donation and allocation | Planned date once donor and recipient are cleared |
| Graft | Usually a whole liver | Right lobe, left lobe or left lateral segment |
| Risk to another person | None | A small but real risk to the donor |
| Main limitation | Too few donors for the number of patients waiting | Needs a suitable, willing and legally approved donor |
How a patient gets on the waiting list
- 1
Transplant evaluation
The patient is assessed by the transplant team — blood tests, scans, heart and lung checks, infection screening and a psychosocial review. This is explained in detail in liver transplant evaluation.
- 2
Decision by the transplant team
The team decides whether a transplant is needed, whether the patient is fit enough to survive it, and that there is no reason (such as active alcohol use or cancer that has spread) that would make it unsafe or futile.
- 3
Registration with the state network
The hospital registers the patient on the state deceased-donor waiting list with their blood group, diagnosis and severity score. Registration is done by the licensed transplant hospital, not by the family directly.
- 4
Staying active on the list
Scores are updated with fresh blood tests at intervals set by the team, because a patient who becomes sicker may move up. Missing tests or becoming unreachable can make a patient temporarily inactive.
Liver disease severity is usually measured with the MELD score (PELD for young children), calculated from bilirubin, INR, creatinine and sodium. Higher scores mean a higher short-term risk of dying without a transplant. Many state allocation systems use this score, alongside blood group and hospital rotation, to decide who is offered a liver first. Patients with acute liver failure are usually given the highest priority.
How livers are allocated in India
Allocation is run by the government organ-sharing network, not by individual hospitals or doctors. The broad order is: patients in the same state first, then the region, then the whole country, through the national system coordinated by NOTTO (National Organ and Tissue Transplant Organisation). Within a state, the rules consider blood group compatibility, urgency and severity score, and often a rotation between transplant hospitals.
What families should know
Organ allocation is transparent and cannot be influenced by payment or recommendations. Anyone offering to arrange a deceased donor liver for money is breaking the law. Waiting time cannot be predicted: it depends on how many families in the region agree to donate, and blood group O and B patients often wait longer.
Because deceased donation rates in eastern India remain low compared with the number of people who need a liver, many patients from West Bengal, Bihar, Jharkhand, Odisha, Assam and the North-East are advised to explore a living donor at the same time. Registration for a deceased donor and assessment of a living donor are not mutually exclusive.
When the call comes
A liver offer can come at any hour. The transplant coordinator phones the family, and the patient is asked to come to the hospital immediately and stop eating and drinking. While the patient travels, the transplant surgeon reviews the donor's details — age, cause of death, blood tests, time in intensive care and the appearance of the liver at retrieval — to decide whether the liver is suitable.
- Keep the phone on and charged at all times, and give the coordinator two or three alternate numbers.
- Keep a bag ready with ID documents, medicines, recent reports and a list of family contacts.
- Families living outside Kolkata should plan how they would reach Narayana RN Tagore Hospital, Mukundapur within a few hours; some stay nearer the hospital while their score is high.
- Tell the coordinator at once about fever, infection, bleeding or a hospital admission — these can affect whether it is safe to operate that day.
Sometimes a patient is called in and the transplant does not go ahead — the liver turns out to be unsuitable once it is examined, or the patient has a new infection. This is disappointing but it is a safety decision. The patient stays on the list.
The operation and the first weeks
The donor liver is kept cold in preservation fluid and should be transplanted within hours of retrieval. The operation usually takes around six to ten hours. The surgeon removes the diseased liver, then joins the new liver's major vein (the vena cava or hepatic veins), the portal vein, the hepatic artery and the bile duct. Patients with severe portal hypertension or previous abdominal surgery can need a longer, more complex operation.
Most patients spend a few days in the transplant intensive care unit and are usually in hospital for about two to three weeks, depending on how sick they were before surgery. Immunosuppressive medicines to prevent rejection start immediately and are lifelong. The early weeks are covered step by step in recovery after liver transplant.
Risks include bleeding, the new liver working slowly at first (early graft dysfunction), clots in the hepatic artery or portal vein, bile leaks or narrowing, rejection and infection. Deceased donor livers vary in quality, and the surgeon weighs the condition of the liver against how urgently the patient needs it. Large centres commonly report one-year survival of around 85–90% after liver transplant, though individual risk depends on how unwell the patient is at the time.
Split-liver and domino transplants
Split-liver transplant
One good-quality deceased donor liver is divided into two grafts: the smaller left lateral segment usually goes to a child, and the larger right part to an adult. It helps more patients benefit from a single donation, but it is only possible when the donor liver is healthy and both recipients are suitably matched. Children needing a liver are discussed on the paediatric liver transplant page.
Domino liver transplant
A patient with certain inherited metabolic diseases — such as maple syrup urine disease or familial amyloid polyneuropathy — receives a transplant. Their own liver, structurally normal apart from the single enzyme or protein defect, can then be transplanted into a carefully selected second patient. The second recipient accepts a small, well-understood long-term risk in exchange for a timely transplant.
Neither option is available on demand; they depend on the right donor and recipients being available at the same time. The transplant team will say if your situation could involve one of them.
Discussing deceased donor listing with Dr Har
Dr Bappaditya Har is a liver transplant and HPB surgeon at Narayana RN Tagore Hospital, Kolkata, and performs both deceased donor and living donor liver transplants within a multidisciplinary team of hepatologists, transplant anaesthetists, intensivists and transplant coordinators. Families can send reports on WhatsApp (+91 70420 39420) before travelling, or call 080675 06860 for an appointment. Questions about expenses and insurance are covered on the liver transplant cost page.
Frequently asked questions
How long is the waiting list for a deceased donor liver in Kolkata?
No one can honestly give a fixed waiting time. It depends on how many families donate, the patient's blood group and severity score, and state allocation rules. Some patients receive a liver quickly; others wait many months, and some become too unwell while waiting. That is why a living donor is often discussed in parallel.
Can I register on more than one waiting list?
Registration rules are set by the national and state networks and have changed in recent years. Your transplant coordinator will explain the current rules for your situation, including for patients from other states.
Is a deceased donor liver as good as a living donor liver?
Both give good results when the graft is suitable. A deceased donor usually gives a whole liver, while a living donor graft is planned and can be timed before the patient becomes too sick. Each liver offered is judged on its own quality.
Can patients from Bangladesh or other countries receive a deceased donor liver in India?
Allocation rules give priority to Indian citizens, and access for foreign nationals is very limited. Most international patients receive a living donor transplant. See liver transplant for Bangladesh patients.
Does the donor's family receive money or pay anything?
No. Buying or selling organs is a criminal offence under THOTA. The donor family does not pay for organ retrieval and does not receive payment.
What happens if I get sicker while waiting?
Tell the transplant team straight away. Updated blood tests may raise your MELD score and priority. The team also treats complications such as fluid, infection or confusion so that you remain fit enough for surgery.
Related reading
Liver Transplant in Kolkata →
Evaluation, surgery and recovery — the complete transplant pathway.
Living Donor Liver Transplant →
A family member donates part of their liver; both recover.
Liver Transplant Evaluation: Who Needs It, MELD Scores and the Tests →
Who needs a liver transplant, what MELD and PELD scores mean, the tests in a transplant work-up, reasons transplant may not be possible, and what to bring.
Liver Transplant Cost in Kolkata →
What drives the cost and how families plan for it.
Recovery After a Liver Transplant: From Theatre to the First Three Months →
What recovery after a liver transplant looks like: ICU and ward days, drains, hospital stay, discharge, early blood tests, complications and when to call.
This page is general patient information, not a diagnosis or a substitute for a consultation. Treatment decisions depend on each patient's reports and examination. Read our medical disclaimer and editorial policy.