IssueMarch 21Opinion

PPP in Action

An Affordable Liver Transplantation Initiative for Children

Rising healthcare costs often negate the impressive gains India has made in poverty alleviation. Approximately, 63 million people are pushed back into poverty every year because of catastrophic out-of-pocket healthcare costs. Effective mechanisms to fund costly treatment like transplantation are not available to the majority of the Indian population.


Children with organ failure represent a particularly unique and vulnerable group. While over 2,500 children in India are in need of a liver transplantation every year, less than a 150 get access to one. An estimated 2000 children die of liver failure in India every year, and almost all these deaths are preventable with appropriate surgery. Besides, 90 per cent of these children fail to receive transplantation primarily due to lack of financial resources or delayed detection.

Tough Challenge

Children are a rewarding group to treat. Diseases causing end-organ failure in childhood are often genetic or environmental, and transplant can be curative. Most parents voluntarily come forward as organ donors should children require a transplant. The skills and facilities for performing complex surgery exist in the private and the public sector. Economic factors are often the only reason why transplants are not performed for children.

Hospitals are often reluctant to undertake these surgeries because of lack of insurance coverage for unexpected cost escalations (due to surgical or medical complications), and a lack of guaranteed long-term support for medicines and laboratory tests which these children need.

(L-R) Dr Sonal Asthana, Lead Consultant, HPB and, Multiorgan TransplantSurgery, Aster Integrated Liver Care (ILC), group, Aster group of Hospitals and Pravin Agarwal, Founder of The Pravin Agarwal, Foundation and Chairman, Sterlite Power Transmission

Winning Strategy

Utilising funding combining crowdfunding supported by corporate social responsibility for healthcare has the potential to be a game-changer in healthcare delivery as well as outreach. Selected private/ corporate partners can provide knowledge and skills transfer as well as a potential source of funding for a catastrophic expense.

We have created a funding mechanism for an affordable liver transplant for children over the past three years using a combination of CSR funding and crowdfunding. This involved key stakeholders to ensure pricing control and equitable distribution of funding burden to avoid burdening the family with unsustainable expenses.

The Internet has lowered search and communication costs allowing funders to easily gather information, monitor their investment, and engage with the social platform coordinating funding, regardless of their geographic location. The average donation per patient for our children was Rs 2500 (approx. 35 USD).

Key Funding Partners

The Pravin Agarwal Foundation (TPAF) and Help the poor foundation have supported more than 300 transplants across more than 20 partner hospitals in India. Our unit at Aster hospitals has performed 101 transplants for children using a supported funding mechanism.

“The cost of a liver transplant surgery Pravin Agarwal, Founder of The Pravin Agarwal Foundation and Chairman, Sterlite Power Transmission is very expensive and the reason why many who are in need cannot afford one. At TPAF, through our fundraising campaigns we are trying to bridge that economic gap. If a disease can be taken care of through transplant, funds shouldn’t be a reason to lose an innocent life. As an organisation, we also try to be an ecosystem enabler by partnering with super-speciality hospitals facilitate surgeries at a fixed rate. We also extend post-transplant support through our support groups. In the year 2020, we supported our 200th paediatric transplant since our inception. We hope to touch many more lives in the coming years,” says Pravin Agarwal, Founder, The Pravin Agarwal Foundation and Chairman, Sterlite Power Transmission.

This novel approach to healthcare funding and delivery may help supplement the government’s efforts to expand healthcare coverage under the PMJAY by providing additional funding for advanced and relatively expensive healthcare interventions and help us to truly provide equitable and affordable healthcare for all.

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