What Makes a Leading Pediatric Liver Transplant Centre
Choosing the right hospital is the single most important decision a parent will make. Pediatric liver transplant is not the same as adult transplant scaled down — it calls for a different surgical technique, different anaesthesia, and round-the-clock care built around a child. When families search for the best pediatric liver transplant hospital in Delhi, these are the factors that matter most:
- Surgical volume and experience. Outcomes improve sharply with the number of pediatric cases a team handles. Our team has completed over 100 pediatric transplants.
- A dedicated pediatric liver ICU. Children recover in a specialist paediatric ICU staffed by pediatric intensivists, hepatologists and nurses, available 24/7.
- Living and deceased donor programmes. Access to both living donor liver transplant and deceased donor liver transplant, plus split liver transplantation, so the right option is available for every child.
- Family-centred support. Clear communication, nutritional and psychological support, and guidance for parents at every stage.
When Does a Child Need a Liver Transplant?
Biliary Atresia — The Most Common Indication
Biliary atresia is a condition present from birth in which the bile ducts, the tubes that carry bile from the liver to the intestine, are absent, blocked or damaged. Without working bile ducts, bile builds up in the liver and causes progressive damage and cirrhosis. It is the single most common reason children in India require a liver transplant.
The first line of treatment is the Kasai procedure (portoenterostomy), a surgery that creates a new bile drainage route. When the Kasai procedure fails, or is done too late, liver transplantation becomes necessary, ideally before irreversible damage sets in.
Other Common Indications in Children
- Alagille Syndrome — a genetic disorder causing abnormal bile duct development and progressive liver disease.
- Progressive Familial Intrahepatic Cholestasis (PFIC) — genetic disorders causing bile build-up and liver damage.
- Wilson's Disease — copper accumulation causing liver failure, often in older children and teenagers.
- Acute Liver Failure in Children — sudden liver failure from viral infection, drug reactions or autoimmune hepatitis.
- Autoimmune Hepatitis — the immune system attacks liver cells, causing progressive damage.
- Metabolic Liver Diseases — including alpha-1 antitrypsin deficiency, glycogen storage diseases and tyrosinaemia.
- Hepatoblastoma — a liver cancer of very young children, where transplant may be curative.
Types of Pediatric Liver Transplant
Living Donor Liver Transplant for Children
This is the most common type of pediatric transplant in India. A parent or close relative donates the left lateral segment of their liver, a smaller portion of roughly 20 to 25% of the adult liver, which is perfectly sized for a child. Both the donor's remaining liver and the transplanted segment regenerate to full size within weeks. A living donor liver transplant allows planned, timely surgery, which is critical for a child whose liver function is declining, and avoids the uncertainty of a waiting list.
Deceased Donor Liver Transplant for Children
When no suitable living donor is available, the child is listed on the NOTTO (National Organ and Tissue Transplant Organisation) pediatric waiting list, which gives children priority in many cases. A deceased donor liver transplant may use a whole organ for older children or a split organ for younger ones.
Split Liver Transplant
A split liver transplant divides a single deceased donor liver into two portions so that two recipients, typically one adult and one child, can both benefit from a single donated organ. This expands the pool of organs available to children.
Signs Your Child May Need a Liver Transplant
Seek urgent specialist evaluation if your child shows any of the following:
- Persistent jaundice after the newborn period — yellow skin or eyes that do not clear.
- Pale, chalky or grey stools in a newborn, a key warning sign of biliary atresia.
- Abdominal swelling or a noticeably enlarged liver or spleen.
- Poor feeding, failure to thrive or unexplained weight loss.
- Excessive tiredness, lethargy or developmental delay.
- Recurrent fever or infections.
- Easy bruising or unexplained bleeding.
- Confusion, irritability or behavioural changes, which can point to hepatic encephalopathy.
For newborns: If your baby has jaundice lasting beyond 2 weeks of age and pale stools, seek immediate pediatric liver specialist evaluation. Early diagnosis of biliary atresia and Kasai surgery before 60 days of age significantly improve outcomes.
Pre-Transplant Evaluation for Children
A thorough evaluation prepares your child for surgery and identifies any issue that should be addressed first. Our multidisciplinary team works to minimise risk and give every child the smoothest possible recovery.
- Blood tests: full blood count, liver function tests, coagulation screen and blood group typing.
- Infection screening: viral hepatitis panel (HBV, HCV), CMV, EBV and an immunological panel.
- Abdominal ultrasound with Doppler: assesses the liver, portal vein and spleen.
- CT or MRI abdomen: detailed imaging for surgical planning and liver volume assessment.
- Cardiac evaluation: ECG and echocardiogram to confirm the heart is fit for surgery.
- Nutritional assessment: many children with liver disease are malnourished, and optimising nutrition before surgery is essential for healing.
- Developmental and psychological assessment: of the child's readiness and the family's support systems.
- Vaccination review: ensuring all childhood vaccinations are up to date before transplant.
The Pediatric Liver Transplant Journey, Step by Step
- Specialist consultation. Dr. Ashish George reviews your child's diagnosis, current condition and the urgency of transplant, and explains the full process to parents.
- Pre-transplant workup. Complete evaluation of the child, plus donor evaluation (for a living donor) or NOTTO listing (for a deceased donor).
- Optimising the child's condition. Nutritional support, treatment of infection and management of complications so the child is in the best possible shape for surgery.
- Surgery. The diseased liver is removed and replaced with the donor liver segment. Duration is typically 8 to 12 hours.
- Pediatric ICU care. Dedicated monitoring in our pediatric liver ICU with specialist nursing, intensivists and hepatologists available 24/7.
- Hospital recovery. Most children are discharged within 14 to 21 days, with diet and activity reintroduced gradually.
- Long-term follow-up. Lifelong immunosuppressive therapy and structured post-transplant monitoring, with regular blood tests and developmental checks. Most children go on to achieve normal growth and development.
Life After a Pediatric Liver Transplant
Recovery and Returning to Normal Life
- Hospital stay: most children go home within 14 to 21 days of surgery.
- Return to school: usually 2 to 3 months after transplant.
- Physical activity: resumed gradually over 3 to 6 months, and most children can play sports.
- Growth and development: children who receive timely transplants typically reach normal milestones.
- Immunosuppression: required lifelong and managed as a simple daily routine. Read more about immunosuppressive therapy after transplant.
Long-Term Outcomes
Long-term results for pediatric liver transplantation have improved remarkably. The vast majority of children who receive a transplant go on to live full, healthy, active lives. With proper follow-up and medication adherence, a transplanted liver can last for decades.
- 1-year graft survival: 85 to 90%
- 5-year patient survival: 80 to 85%
- Long-term quality of life: comparable to the general pediatric population in most patients
Pediatric Liver Transplant in India — Why Families Choose Delhi
India is one of the world's leading destinations for pediatric liver transplant surgery, combining highly experienced surgical teams with a fraction of the cost of comparable care in the West. Our Delhi centre treats children referred from every part of the country, supported by NOTTO's national organ allocation system and a full living donor programme. For families weighing where to go for pediatric liver transplant surgery in India, an experienced, high-volume team with a dedicated children's ICU offers the best chance of a successful outcome.
If you would like to understand the likely cost, timeline and donor options for your child, contact our team for a detailed consultation.
