NEW DELHI: Liver transplants in India are facing a strange hurdle — fatty liver . Top surgeons say nearly 50% of livers from live donors and 80% of those from cadavers are rejected because there is excess accumulation of fat in the organ.With increasing obesity, diabetes and metabolic syndrome, doctors fear the rate of rejection may go up further.“A liver that’s up to 20% fatty is accepted for donation. When a donor is diagnosed with 20-30% fat in the liver, we try to put him or her on special diet and strict exercise regimen to reduce the fat. But those with higher percentage of fat are outrightly rejected,” said Dr Subhash Gupta, chief liver surgeon at Apollo hospital in New Delhi.He said unlike donors in the western world, Indians who are lean may also have fatty liver. Though no one knows the exact cause of it, scientists blame our genetic predisposition for the condition.“The liver resides in close proximity to intestines. It is thought that non-Caucasians (including Indians) have a different bacterial population that interacts with the immune system and sends signals to the liver which makes us accumulate more fat,” said Abhijit Chowdhury, a Kolkata-based hepatologist who is researching on lean people with non-alcoholic fatty liver disease.How does fatty liver affect a transplant? According to Dr A S Soin, who heads the Medanta Liver Institute, retrieving a portion of the liver from a person suffering from the condition could put both the donor and the recipient’s life at risk.“In a liver transplant, we take out a portion of the liver from the donor and place it in the diseased patient. But if the liver fatty, the donor may suffer from organ failure due to reduced capacity of the remaining organ to process food. The recipient is also at risk for developing toxicity which is fatal,” Soin said.To counter the problem, most transplant centres ask family members to reduce liver fat. “If one can reduce 10% of the body weight in one and a half months, he or she can be considered a donor. Clinical experience shows 10% weight reduction leads to significant reduction in liver fat. For that, we suggest rigorous exercise, diet modification including limiting the intake of food items containing complex sugar such as carbonated drinks and medications such as vitamin E,” said Dr S K Sarin, director of the Institute of Liver and Biliary Sciences (ILBS).At Apollo hospital, officials said, a 48-year-old woman suffering from liver failure due to an auto-immune disorder underwent transplant recently. Her husband, who weighed 85kg, lost 5kg in a few weeks and was able to donate his organ to his wife. “I wanted to save her at any cost,” he said.Every year, more than 60,000 people die in India due to liver failure. At most, 1,500 lives are saved with liver transplant — the only treatment option available to such patients — due to lack of donors. “The irony of the situation is that more people are suffering from liver failure due to fatty liver disease. But the number of people who can donate is also reducing due to the same condition,” said Sarin.