Who Can Be a Liver Donor? Eligibility & Legal Process

Key points

Donors are usually healthy adults aged 18 to about 55, with a compatible blood group (or an ABO-incompatible plan), a healthy weight and little or no fat in the liver.
The donor's liver must be large enough to give the recipient an adequate graft while leaving the donor at least about 30–35% of their liver.
Under THOTA, donors must be near relatives, or be approved by the hospital or state authorisation committee. Any payment is illegal.
A donor can withdraw at any time before surgery, and the team will protect the reason as confidential.

Medical criteria for a living liver donor

Criteria differ slightly between programmes and are applied to each donor individually.
Factor	Usual requirement	Why it matters
Age	18 to about 55 years; some programmes consider fit donors a little older	Older livers regenerate more slowly and surgical risk rises with age
Blood group	Compatible with the recipient (for example, O can donate to anyone); otherwise an ABO-incompatible transplant may be considered	Blood-group antibodies can damage an incompatible graft
Body mass index (BMI)	Commonly below about 28–30	Higher weight is linked to fatty liver and more surgical complications
Fatty liver	Little or no fat on scans or biopsy — for right-lobe donation, usually under about 10%	A fatty graft works less well and the donor's remnant regrows less reliably
Liver volume	Graft big enough for the recipient; donor keeps at least about 30–35%	Protects both the recipient's new liver and the donor's safety
General health	No significant heart, lung, kidney or liver disease; no uncontrolled diabetes or high blood pressure; no active infection or cancer	The donor must be healthy enough for a major operation

Some donors who are initially unsuitable because of mild fatty liver or a raised BMI can become suitable after a supervised period of diet and exercise, if the recipient's condition allows time for this. Alcohol use, smoking and certain medicines are reviewed carefully. Women who are pregnant cannot donate.

The donor evaluation, step by step

Evaluation is done in stages so that a donor who is ruled out early is spared unnecessary tests. It usually takes several days to a couple of weeks.

1
Blood group and initial blood tests
Blood group, liver and kidney function, blood counts, clotting, sugar and thyroid tests, and screening for hepatitis B and C and HIV.
2
Ultrasound and FibroScan
A first look at liver size and fat content.
3
CT volumetry and imaging of the blood vessels and bile ducts
A contrast CT measures the volume of each part of the liver and maps its arteries and veins; an MRCP maps the bile ducts. These decide whether donation is feasible and which graft can be taken.
4
Heart and lung assessment
ECG, echocardiogram, chest X-ray and lung function tests; further heart tests for older donors.
5
Psychological assessment and counselling
A psychologist or psychiatrist confirms that the donor understands the risks, is choosing freely and has support during recovery.
6
Independent medical review
The donor meets doctors — including the surgeon and anaesthetist — to discuss risks privately. A liver biopsy is done only in selected cases when scans leave doubt about fat or other disease.

The operation itself, the choice between open, laparoscopic and robotic surgery, and recovery are explained on the liver donor surgery page.

The legal process under THOTA

Living organ donation in India is governed by the Transplantation of Human Organs and Tissues Act, 1994 (amended in 2011) and the rules made under it. The law exists to protect donors from coercion and to prevent organ trade.

Near relatives

Spouse, son, daughter, father, mother, brother, sister, grandfather, grandmother, grandson and granddaughter. The relationship must be proven with documents, and the hospital's authorisation committee still reviews and approves the case.

Donors who are not near relatives

Other relatives or friends may donate "out of affection or attachment" only with approval from the authorisation committee, which examines the relationship and looks carefully for any sign of payment or pressure.

Swap (paired) donation

When a near relative is willing but incompatible, two families can exchange donors. Swap transplants also need authorisation committee approval.

Foreign nationals

For donors and recipients from other countries, such as Bangladesh, the relationship must be certified by the relevant embassy or government, and the case goes before the authorisation committee. See liver transplant for Bangladesh patients.

Proof of identity and address for donor and recipient.
Proof of relationship — for example birth certificates, marriage certificate, family documents, and in some cases genetic (DNA) testing.
The prescribed application forms and affidavits under the THOTA rules, signed by the donor and recipient.
Recent photographs and, where required, a joint photograph of donor and recipient.
An interview of the donor and family by the authorisation committee, which is recorded.

No payment, ever

Buying or selling an organ, or offering or receiving any payment or reward for donation, is a criminal offence under THOTA for everyone involved — donor, recipient, middlemen and doctors. Reimbursement of legitimate medical expenses through the hospital is not payment. If anyone offers to arrange a donor for money, refuse and tell the transplant team.

The transplant coordinators at Narayana RN Tagore Hospital, Kolkata, guide families through the paperwork. Starting the documentation early — while the medical evaluation is under way — avoids delays.

The donor's right to say no

Donation must be a free choice. Family expectations can be strong, and the transplant team is aware of this. A potential donor can withdraw at any stage up to the moment of anaesthesia, without giving a reason. The team will not disclose why a donor withdrew; the family is simply told that the donor is not suitable.

Donors should also feel free to ask about anything that worries them — pain, time off work, effects on future pregnancy, life insurance, or what happens if a complication occurs. Every donor should have the chance to speak to the team without the recipient's family present.

If you are thinking of donating

Start by finding out your blood group and sharing it, along with the recipient's reports, with the transplant team. Dr Bappaditya Har performs living donor liver transplants at Narayana RN Tagore Hospital, Mukundapur, Kolkata, including laparoscopic and robotic donor surgery. Send reports on WhatsApp (+91 70420 39420) or call 080675 06860. The recipient's own work-up is described in liver transplant evaluation.

Frequently asked questions

Can a wife donate liver to her husband in India?

Yes. A spouse is a near relative under THOTA. The marriage must be documented, and the donor must pass the full medical and psychological evaluation and be approved by the authorisation committee.

Can a friend be a liver donor?

Possibly, but only with approval from the authorisation committee, which must be satisfied that the donation is out of genuine affection and that no money or pressure is involved. The process is stricter and takes longer.

What is the maximum age to donate a liver?

Most programmes accept donors up to about 55, and some consider very fit donors a little older. The decision depends on overall health and liver quality, not age alone.

Can a person with fatty liver donate?

Mild fatty liver can sometimes be reversed with diet and exercise, after which the donor is reassessed. Significant fat usually rules out donation, especially of the right lobe.

Does blood group have to match for liver donation?

Ideally yes, but not always. If the only willing donor has an incompatible blood group, ABO-incompatible transplant or swap donation may be options.

Can a donor change their mind?

Yes, at any time before surgery, without giving a reason. The team keeps the reason confidential.

Who Can Be a Liver Donor? Eligibility, Tests and the Legal Process in India