Ethics of Transplantation in Countries with Limited Resources

  • Mohamed Rela
  • Mettu Srinivas Reddy
Reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)


Transplantation is a complex and expensive procedure; the success of which depends on the availability of good medical infrastructure, trained professionals, and a public sensitized to the concepts of deceased organ donation and live donation. Many countries in Asia and Africa with limited resources do not have these structures in place. Basic public health problems among children such as malnutrition and infectious diseases are given precedence over transplantation in these countries. A viable and equitable pediatric organ transplant program requires a system-wide approach – starting with early diagnosis, timely referral, and coordination between the public and private healthcare sectors. This chapter discusses the issues involved in setting up pediatric transplant facilities in countries with limited resources, using the example of pediatric liver transplantation in India.


Liver transplantation Countries with limited resources Deceased donation Living donation Biliary atresia Public private partnership 


  1. Balarajan Y et al (2011) Health care and equity in India. Lancet 377(9764):505–515CrossRefPubMedPubMedCentralGoogle Scholar
  2. Dangwal TR et al (1997) Clinical spectrum of chronic liver disease in north Indian children. Trop Gastroenterol 18(4):174–176PubMedGoogle Scholar
  3. Kesterton AJ et al (2010) Institutional delivery in rural India: the relative importance of accessibility and economic status. BMC Pregnancy Childbirth 10:30CrossRefPubMedPubMedCentralGoogle Scholar
  4. Kyu HH et al. (2016). “Global and national burden of diseases and injuries among children and adolescents between 1990 and 2013: findings from the global burden of disease 2013 study.” JAMA Pediatr 170(3):267–87Google Scholar
  5. Mogul D et al (2015) Cost-effective analysis of screening for biliary atresia with the stool color card. J Pediatr Gastroenterol Nutr 60(1):91–98CrossRefPubMedGoogle Scholar
  6. Nagral S, Amalorpavanathan J (2014) Deceased organ donation in India: where do we go from here? Indian J Med Ethics 11(3):162–166PubMedGoogle Scholar
  7. Narasimhan G et al (2016a) Liver transplantation in India. Liver Transpl 22(7):1019–1024CrossRefPubMedGoogle Scholar
  8. Narasimhan G et al (2016b) Donor outcomes in living donor liver transplantation-analysis of 275 donors from a single centre in India. Transplantation 100(6):1251–1256CrossRefPubMedGoogle Scholar
  9. Network, O. P. a. T. (2016) National dataGoogle Scholar
  10. Ramachandran P et al (2015) Recent trends in the diagnosis and management of biliary atresia in developing countries. Indian Pediatr 52(10):871–879CrossRefPubMedGoogle Scholar
  11. Sibal A et al (2014) Experience of 100 solid organ transplants over a five-yr period from the first successful pediatric multi-organ transplant program in India. Pediatr Transplant 18(7):740–745CrossRefPubMedGoogle Scholar
  12. Vania DK, Randall GE (2016) Can evidence-based health policy from high-income countries be applied to lower-income countries: considering barriers and facilitators to an organ donor registry in Mumbai, India. Health Res Policy Syst 14(1):3CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Institute of Liver Disease and TransplantationGlobal Health CityChennaiIndia
  2. 2.National Foundation for Liver ResearchChennaiIndia

Section editors and affiliations

  • Ashley L J D'Cruz
    • 1
  1. 1.Solid Organ Transplant ProgramNarayana Hrudayalaya Woman and Child InstituteBangaloreIndia

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