Future Economics Of Liver Transplant In India

Liver transplants have been a standard treatment option for the severest of cases of liver failure in both adults and children. According to statistics and research, about 16,000 patients are on liver transplant lists at any given time, waiting to get a liver. Unfortunately, only about 38% of these receive a transplant because of the organ shortage. Based on the technology used, the current cost of a liver transplant is high, and according to future projections, the cost will increase, especially when compared with the bioengineering autologous liver grafts. Here is what the future economics of liver transplant looks like in India.

Projected Demand

The projected demand for liver transplants is expected to increase by 10% in the next ten years and 23% in the next 20 years. Apart from demand, the cost of these transplants is forecast to rise by 33% in 10 years and to 81% in 20 years. According to this comparison and demand, the cost of bioengineering autologous liver grafts is ranking high as per the current catalog prices for iPS-derived liver cells.

There is a persistent increase in liver transplant costs and the need for liver donors in India. It will continue in the next 20 years, which will be constrained by the limited supply of donor lives. The number of liver failure patients who die while on the waiting list reflects this ever-growing despair. According to the current bioengineering of autologous liver grafts, the cost is prohibitive. However, this cost will decline with the advent of new strategies and manufacturing infrastructure.

The Growth Of Liver Transplants

Unfortunately, liver transplantation has been a victim of its success in many ways. As the transplantation technology and science evolved, there were indications of expansion to include the many causes of chronic and acute liver failure, inherited metabolic diseases, cirrhosis, and in some cases, liver cancer. Yet, the number of donor’s  livers still fails to keep up with the growing demand, and in some states, it is losing ground.

Every year, the number of donor livers decreases, and the number of living donors declines. As a result, there are always about 16,000 people waiting for a liver transplant. Unfortunately, less than half of them manage to receive a liver transplant. To worsen the situation, the donor pool is expected to decline even further due to the obesity epidemic. In addition, there are other risk factors surrounding the donor’s liver, and live steatosis is becoming a major issue affecting the transplantation.

Strategies To Increase Donor Livers

The medical sector is in constant trials and conventions to try and increase the number of livers available for transplants. Some of these unconventional ways include;

  •  using marginal donors, 
  • donor with greater than 30% hypernatremia or macrosteatosis,
  • Ill-defined donor group which comprises individuals over 60 years 
  • Donors with positive serologies for the hepatitis C or hepatitis B virus
  • non-heart-beating donors
  • Graft from split-livers or living-related donors
  • Donors with a cold ischemia time of greater than 12 hours
  • Production of pigs with genetic manipulations
  • Resuscitation of marginal quality donor organs using machine perfusion

Unfortunately, all these ways have presented various logistic and practical difficulties.

The liver can regenerate completely after a liver failure. It also benefits from the temporary methods of hepatic support and hepatocyte transplantation. Additionally, auxiliary liver transplantation has also developed as an effective therapeutic option for patients suffering from acute liver failure and liver metabolism errors. However, this approach has some inherent limitations, like orthotopic liver transplantation.

Cost Projection Of Manufacturing Liver Grafts

Manufacturing and making a universal availability of liver grafts from autologous tissue and cells would greatly change the paradigm of organ transplantation, increasing the organs available for transplant. This way, there won’t be a need for life-long immunosuppressive drugs and the complications that come with them. Moreover, with several strategies in place to construct a whole organ using a decellularized whole organ matrix, liver transplant costs in India will see a significant reduction as it will provide a means to meet the high demand.

The engineering of pluripotency of human somatic cells using ectopic expression of transcription factors has helped open the possibility of generating autologous cells for organ and cell replacement therapies. For example, there is a need to perform liver transplantation widely now that scientific elements are coming together. Bioengineering a liver using autologous cells would be easy.

Liver transplantation is the ideal remedy for last-stage liver disease, and thus, more transplants are needed. Unfortunately, the death of organs is another major problem facing transplant medicine. While half of those on the waiting list die because of a lack of a liver for transplant, one in that number die because of an organ death. Remember, the number of those on the waiting list represents the true fraction of those who need liver transplants. According to most clinicians, most people are excluded from the waiting list because they have not yet reached the critical stage of needing a liver transplant.

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