Time to Frame a Standard Protocol for Inspecting Authority for a New Liver Transplant Center: An Enigma not yet Unlocked

Dear Editor, The story starts in October 2021 when I joined a super specialty hospital after gaining my necessary experience in liver transplantation from a reputed world-class high-volume center in India. The process of submitting an application for seeking permission for a new liver transplant center to the concerned authority was soon completed. The task was allotted to one of the recently recognized medical college in the state with a 3-member team comprising of a general physician, general surgeon, and general anesthetic. Two meetings were held physically over certain time with inspection and verification of what was required. While we were waiting for the response to last meeting, we were astonished by one of the points in a letter from the committee approximately 1.5 years after the application stating and expecting an expert in the field of liver transplantation to guide in the matter. The state authority re-allotted the task to the new inspecting committee but to another state medical college this time, comprising of the specialties as for previous one. Even though they also did not have any experience in the liver transplantation, we got the approval eventually in October 2023 when everything was found in place for a new center. During this phase, all the living donor liver transplants for the patients of this hospital were done at an already established center under whom supervision this center was coming up. It is a matter of concern for a public or private sector to wait for such a long time for the approval. Now the questions which do arise, is the same system is being followed up in other states or UTs also, are there some set protocols for the inspecting committee, are the number and specialties of the committee members defined and finally is there any time period defined? In most of the big forums, there is debate on infrastructure 1st or manpower 1st. However, is there a discussion on inspecting authorities, their experience and expertise or it’s just a matter of paper work and formalities. The Gazette of India,[1] point 26 under section C, defines the expert and qualifications related to the surgeon but there is no mention of expert committee panel for a licensing authority. With so many young surgeon seeking their carrier in the field of liver transplantation, the increasing burden of liver disease and large numbers of new centers emerging up, we strongly believe that this is the time to frame a standard protocol for inspecting authority for a new liver transplant center, an enigma not yet unlocked. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.