In Gandhi’s ‘dry’ Gujarat, alcohol's the root cause of liver failure deaths

Data shared by State Organ Tissue Transplant Organisation (SOTTO), which monitors organ donations in the state, says that 40 per cent of the patients who underwent liver transplantation at the Institute of Kidney Disease and Research Centre (IKDRC) in Asarwa Civil Hospital, the largest government hospital in the state, in the past two years, died within a year of surgery. Doctors say, a decade back, alcohol consumption accounted for only 20 per cent of deaths due to liver failures.

Also read: Drinking alcohol, a habit India loves to hate yet can’t do without

Alarming trend

The fatalities have prompted Gujarat Health Minister Rushikesh Patel to order a probe to find the cause behind the deaths.

The data is alarming given Gujarat’s reputation as a dry state for over six decades and a stringent law which mandates punishment up to death penalty for those who engage in manufacturing, sale or consumption (in special cases) of any form of liquor. The free flow of liquor in the state and inability of patients to quit liquor after surgery are said to be the main causes behind these deaths.

Transplants linked to alcohol-related ailments

The SOTTO data also reveals a striking rise in a number of liver transplants at the hospital, with alcohol-related liver diseases being the primary cause of liver failure among operated patients.

Data says that between 2015 and 2023, 60 per cent of the transplant cases were linked to patients who had complications due to alcohol consumption. The number saw a drastic rise to 88.6 per cent, in 2024, with a whopping 532 of the total 600 liver transplants done at IKDRC being cases of liver cirrhosis related to alcohol consumption.

Also read: How Gujarat, a dry state, is drowning in alcohol-laced cough syrups

What causes liver failure?

“A majority of cases we deal with are of alcoholic hepatitis and cirrhosis, which lead to liver failure. Cirrhosis is the advanced stage of a liver disease where the healthy liver tissue is replaced with a scar tissue,” Dr Pranjalraman Modi, head of Urology and Transplant Surgery at IKDRC told The Federal.

“An alcoholic liver disease progresses through stages. The first stage is fatty liver, the second is alcoholic hepatitis (inflammation) and the third is cirrhosis, which finally leads to liver failure. Other factors like fatty liver disease (NASH) and viral hepatitis (Hepatitis B and C) that also contribute to liver damage and necessitate transplantation. But here at IKDRC, a majority of the cases we get are of patients with end-stage liver disease caused by excessive alcohol consumption. A liver transplant is the only life-saving option for such patients,” Modi added.

‘60% of patients can’t let go of liquor’

“After a liver transplant, especially if it was due to alcohol-related liver disease, complete abstinence from alcohol is crucial to prevent damaging the new liver. That’s why while making a decision of a transplant, we consider factors like the patient’s ability to abstain from alcohol along with other medical factors like the severity of liver damage, age and overall health of the patient to survive the surgery and recover well. In many cases, we advise deaddiction therapy for patients. But despite our efforts, 60 per cent of patients give in to alcohol addiction causing a significant rise in post-transplant mortality,” he added.

Also read: Liquor at GIFT City | Dry Gujarat and its fluid relationship with liquor

Robotic intervention

The hospital reportedly bought a robot worth Rs 9.19 crore in 2013 to minimise post-surgical complications.

Between 2015 and 2023, 510 transplants were performed using robotic surgery. However, robotic surgery declined drastically, dropping from 98 surgeries in 2015 to just six in 2022. From 2023, use of the robot stopped completely.

“The robotic surgery requires a lot of preparation time. After each surgery, it needs to be charged and since it is a newer protocol, surgeons need time to practice on dummies. But with the hospital being flooded with cases of liver failure needing transplant, there is no time for any of these necessary steps before robotic surgery,” says Dr Siyyed Rizvan, a hepatologist at Civil Hospital, Ahmedabad.

Also read: Gujarat’s GIFT City: Liquor permit, a pragmatic move to break shackles of old laws

“On an average day, we get 10 to 15 patients who come with alcohol-related liver complications. It is a myth that because alcohol is banned in Gujarat, there is no liver disease in Gujarat. We have been raising the issue since 2010. During the SD Bhardwaj Liver Update Conference in Ahmedabad in September 2010, we had raised the concern. Back then alcohol was cause of about 20 per cent of the cases of liver failure. Now the numbers have increased,” he adds.

Myth of dry state, rise in bootlegging

The Bombay Prohibition Act was passed on May 1, 1960, in Gujarat after the erstwhile Bombay State was bifurcated into the states of Maharashtra and Gujarat. The Act made a permit mandatory to purchase, possess, consume or serve liquor. The law mandated rigorous punishment up to 15 years in jail for flouting rules.

However, despite the law, bootlegging or illegal sale of alcohol has been rampant in the state.

Also read: Ground report | Why most women in Bihar want liquor ban to continue

In the budget session on March 17, 2025, Chief Minister Bhupendra Patel stated that the state government collected Rs 33.98 crore in taxes in two years from sale of liquor through hotels in Ahmedabad and Gandhinagar districts alone.

Patel, who also handles the Prohibition and Excise department, was answering a question raised by the Congress MLA Imran Khedawala.

The chief minister also informed the house, “illegal liquor worth Rs 144 crore was seized in just 2024 out of which around Rs 70 crore worth of liquor were seized from Ahmedabad district alone.”

The data tabled by Patel reveals that between 2022 and 2024, one bottle of alcohol was sold illegally every four seconds in Gujarat in the last two years despite the prohibition laws.

Hooch tragedies

The state has also seen multiple hooch tragedies.

In July 2022, 42 people from Ahmedabad, Surendranagar and Botad districts died and more than 97 were hospitalised in a methanol poisoning incident in Gujarat. The victims had consumed undiluted methyl alcohol or methanol assuming it to be alcohol.

However, the state Home Minister Harsh Sanghvi said, “The deaths were caused by chemical poisoning. This is not a case of alcohol consumption.”

In a similar case in 2009, 136 people had died after consuming methanol. Following the incident, police conducted more than 8,000 raids in the state, booking around 6,000 persons for violation of prohibition.

Also read: Why liquor ban failed to sober up Bihar

Stringent punishment

Later in 2010, the state government introduced a bill in the state Assembly to amend the Bombay Prohibition Law, 1960. Punishment up to death penalty for those who engage in manufacturing, sale or consumption (in special cases) of any form of liquor, were added to the new Gujarat Prohibition Act, 2010.

However, the amended act allowed foreigners and visitors from other parts of India to apply online for a permit. There are 35 stores across the state including nine in Ahmedabad that sell liquor to people with the state permit. Once the permit expires, users are required to hand over the unconsumed liquor to the district collector.