Liver Donor Criteria in India: Who Can Donate a Liver?

Liver Donor Criteria in India: At a Glance

• Who can donate: A healthy adult aged 18-55, with a compatible blood group, BMI ≤30, and no serious medical conditions.
• Legal framework: India’s THOTA Act (1994, amended 2011) defines who qualifies as a “near relative.” Non-relatives can donate via an Authorisation Committee.
• 7 core criteria: Age, blood group, BMI, liver health, no serious illness, no substance abuse, psychological fitness.
• Disqualifying conditions include: Active hepatitis B/C, HIV, uncontrolled diabetes, significant fatty liver (>30% steatosis), active cancer, BMI >30, and psychiatric illness affecting consent.
• The process is thorough and protective. Every test exists to keep the donor safe

(Important: These are general guidelines. Final donor eligibility can only be determined after a comprehensive evaluation by a qualified liver transplant team.)

When a loved one is told they need a liver transplant, one of the first things a family member asks is: “Can I donate?” It is a question born of care, and it deserves a clear answer.

This guide explains the liver donor criteria in India in full: what the law says, what the medical requirements are, who is not eligible, and exactly what happens after you step forward.

What Does It Mean to Be a Living Liver Donor?

A living liver donor is a healthy adult who voluntarily gives a portion of their liver to someone whose liver has failed. Unlike most organs, the liver has a remarkable ability to regenerate. After surgery, both the donor’s remaining liver and the recipient’s transplanted portion grow back to near-normal size – typically within 6 to 8 weeks.

This regenerative capacity is what makes living donor liver transplant possible. It is not a sacrifice of an entire organ. It is a partial donation – and the body repairs itself. That said, it is still major surgery, and the decision must be made with full information and zero pressure.

The Legal Framework – What THOTA Says

India’s Transplantation of Human Organs and Tissues Act (THOTA), 1994, as amended in 2011, is the law governing all organ donation and transplantation in the country. It exists to prevent organ trafficking, protect donors, and ensure that donation is always voluntary.

Under THOTA, a “near relative” is legally defined as:

Spouse, son, daughter, father, mother, brother, sister, grandfather, grandmother, grandson, or granddaughter.

If you fall into one of these categories, you can proceed through the standard transplant evaluation process at a registered hospital.

What if the donor is not a near relative?

Non-relatives – a close friend, for example – can still donate, but only after approval from the State Authorisation Committee. This body verifies that the donation is genuinely motivated by affection or attachment, and that no financial transaction is involved. The process adds a step, but it is not a closed door.

Swap or paired donation is also possible in some cases, where two donor-recipient pairs exchange donors to achieve blood group compatibility.

The 7 Core Criteria Every Liver Donor Must Meet

Meeting the liver donation criteria is about being safe enough to undergo major surgery and recover fully. Here is what the evaluation looks for.

1. Age Between 18 and 55 Years

The donor must be a legal adult – at least 18 years old. The upper limit is typically 55 years, though some high-volume centres may consider donors up to 60 years on a case-by-case basis after careful assessment. Age matters because older donors may have reduced liver regenerative capacity and higher surgical risk. Younger donors, on the other hand, tend to recover faster and have better outcomes for both themselves and the recipient.

2. Blood Group Compatibility

The donor’s blood group must be ABO-compatible with the recipient. This is one of the first checks done – before any other test. In most cases, a matching or compatible blood group is required to reduce the risk of rejection. If blood groups do not match, an ABO-incompatible liver transplant may be possible in select cases. This is not a standard option everywhere, but it exists.

3. Weight and BMI

The donor’s BMI must be 30 or below. Obesity is a major concern because it is strongly associated with fatty liver disease – and a fatty liver does not regenerate as well after surgery. If your BMI is borderline, the team will assess liver fat content directly through imaging or biopsy before making a decision.

4. A Healthy Liver – No Fatty Liver, No Disease

The donor’s liver must be structurally and functionally healthy. Specifically:

• Steatosis (fatty liver) must be below 10-30%. Mild steatosis (under 10%) may be acceptable. Moderate steatosis (10-30%) is evaluated on a case-by-case basis. Severe steatosis (above 30%) is a disqualifying condition – the liver will not regenerate adequately after partial removal.
• No active liver disease, cirrhosis, or hepatitis is acceptable.

CT volumetry – a specialised scan – measures the exact liver volume and determines how much can be safely donated. This is an important part of the donor eligibility and tests process.

5. No Serious Medical Conditions

The donor must be in good general health. Conditions that increase surgical risk or compromise recovery will disqualify a potential donor. These include:

• Uncontrolled diabetes or hypertension
• Active or recent cancer
• Significant heart or lung disease
• Chronic kidney disease
• Autoimmune or inflammatory conditions that affect the liver

6. No History of Alcohol Abuse or Substance Use

Active alcohol dependency or drug abuse disqualifies a donor. This is both a medical and an ethical requirement. Alcohol damages the liver over time, and a donor who is actively drinking may have liver damage that is not yet visible on routine tests. The evaluation includes a detailed history and, where indicated, specialist assessment. A history of past alcohol use that has been fully resolved – with adequate time and confirmed liver health – may be acceptable, but this is assessed individually.

7. Psychological Fitness and Voluntary Consent

A trained psychologist or psychiatrist meets with every potential donor to confirm that:

• The decision is entirely voluntary – made without family pressure, financial incentive, or coercion
• The donor fully understands the risks, the surgery, and the recovery
• There is no psychiatric illness that impairs the ability to give informed consent

No donor is approved under pressure. If the evaluation raises any concern about voluntariness, the process stops – and the donor is protected. This is one of the most important safeguards in the entire system.

Who Is NOT Eligible to Donate Liver? (Disqualifying Conditions)

A Word to Families Reading This

Considering liver donation takes courage. It means being willing to undergo major surgery for someone else’s survival. We see this every day, and we never take it lightly.

Here is what we want you to know: coming in for an evaluation is not a commitment. It is a conversation. It is a way of finding out whether donation is safe for you – and whether it is the right path forward.

If you are eligible and you choose to proceed, you will be supported at every step – before surgery, during recovery, and long after you go home. If you are not eligible, the team will explain why and explore every alternative option for your loved one.

Need Expert Liver & HPB Care?

Whether you’re exploring liver transplant, liver disease treatment, liver cancer care, or living donor transplantation, you can book a consultation to get expert guidance from Dr. Ankur Garg, one of the leading HPB and liver transplant surgeons in Delhi-NCR.