Organ Transplantation in India | 24 Jun 2025

Source: TH 

Why in News?

A recent report by the Union Ministry of Health and Family Welfare has exposed severe gaps in India’s organ transplantation programme, raising concerns over the country’s ability to meet the growing demand for life-saving procedures. 

• With only 13,476 kidney transplants performed in 2024—far below the recommended 1 lakh—the findings underscore an urgent need for systemic reforms to improve access to organ transplants for thousands of patients.

What is Organ Transplantation?

• Definition: Organ transplantation is a life-saving procedure where a failing organ (kidney, liver, heart, lung) is replaced with a healthy organ from a living donor (e.g., kidney, partial liver) or a deceased donor (brain-dead or after cardiac death) to restore function in end-stage organ failure. Common transplants include the kidney, liver, heart, lungs, pancreas, and intestines.
• Status: India is the 3rd country in the world after the USA and China, in terms of the total number of transplants done in a year.
  • Growing Demand and Persistent Shortage: Of 1.8 lakh renal failure cases annually, only 6,000 transplants occur, with a donation rate under 1 per million versus a need for 65 per million.
  • Slow Growth in Donor Numbers: Donor numbers, including living and deceased donors, grew modestly from 6,916 in 2014 to about 16,041 in 2022.
    • The deceased organ donation rate has stayed below one donor per million population for over a decade.
  • Regional Variations: Telangana, Tamil Nadu, Karnataka, Gujarat, and Maharashtra lead in deceased donors, while Delhi-NCR, Tamil Nadu, Kerala, Maharashtra, and West Bengal report the most living donors.
• Rules and Regulations: 
  • Transplantation of Human Organs and Tissues Act, 1994 (amended in 2011): It regulates organ and tissue transplantation in India, covering post-death donation, setting rules for healthcare providers, and prescribing penalties for violation.
    • The 2023 revised guidelines removed the 65-year upper age limit for registering to receive deceased donor organs and ended the state domicile requirement for such registrations.
  • National Organ Transplant Program (NOTP): It is being implemented by the Central Government to promote organ donation and transplantation across all States and Union Territories. Under this, several bodies have been established: 
  • National Organ and Tissue Transplant Organization (NOTTO): The NOTTO, under the Ministry of Health, was set up as per the Transplantation of Human Organs (Amendment) Act, 2011.
    • Its National Network division serves as the apex centre for coordination, procurement, distribution, and maintaining the registry of organ and tissue donation and transplantation in India.
    • 5 Regional Organ and Tissue Transplant Organizations (ROTTOs) and 14 State Organ and Tissue Transplant Organizations (SOTTOs) were established to strengthen the network at the regional and state levels.
  • NOTTO-ID: The Union Health Ministry has directed states/UTs to allocate a unique NOTTO-ID for all organ transplants. It is mandatory for deceased donor organ allocation and must be generated within 48 hours of a living donor transplant surgery.

What are the Gaps in India’s Organ Transplantation Programme?

• Infrastructural Deficiencies: Many government hospitals lack dedicated infrastructure for organ retrieval and transplantation, and face a severe shortage of ICU beds crucial for maintaining brain-stem dead (BSD) donors and post-operative care.
  • Operation theatres (OTs) and ICUs are overburdened with general patient loads, while several centres, including some AIIMS branches, lack in-house Human Leukocyte Antigen (HLA) cross-matching labs, causing delays.
• Shortage of Skilled Transplant Professionals: Government hospitals face a critical shortage of trained transplant surgeons, nephrologists, urologists, anaesthetists, neurologists, neurosurgeons, and intensivists.
  • Frequent transfers, absence of dedicated teams, and lack of incentives for transplant staff disrupt continuity, lower motivation, and hinder the expansion of organ transplantation.
• Procedural Bottlenecks: Delays in approval and formation of Brain-Stem Dead (BSD) Committees, essential for deceased organ donation, remain a major hurdle.
  • Cumbersome handling of medico-legal cases, especially involving trauma patients, and the absence of a streamlined process contribute to significant procedural delays and discourage organ donation.
• Financial Strain: Insufficient funding blocks the initiation or revival of specialised programmes like lung transplantation, while the high cost of immunosuppressant drugs imposes a heavy burden, as most schemes cover only the first year of medication.
  • Liver and heart transplants and their lifelong follow-up costs are excluded from major health schemes like Ayushman Bharat, limiting access for poor patients. 
• Peri-Transplant Donor Tissue Damage: Aging and diseases reduce donor organ quality, leading to Ischemia-Reperfusion Injury (IRI). Many organs are discarded due to inferior quality, impacting transplant success rates.
• Chronic Rejection in Organ Transplantation: Long-term survival rates for transplanted organs have not significantly improved over the past 20 years. Current anti-rejection therapies remain largely unchanged, with only modest improvements in survival rates.
• Access and Awareness Gaps: India’s organ transplantation programme is challenged by the dominance of the private sector, limiting affordable access for poor patients; the absence of green corridors hampers swift organ transport; and low awareness, along with misconceptions about organ donation, discourage public participation.
• Ethical and Legal Challenges: Organ trafficking, commercialisation of organ donation, and a black market for organs persist despite strict laws like the Transplantation of Human Organs and Tissues Act, 1994 (THOT Act, 1994).
  • Consent issues in brain-death certification and criminal activities exploiting organ demand undermine legitimate donation processes.

What Strategies can be Adopted to Enhance the Organ Transplantation Framework in India?

• Enhancing Infrastructure: Upgrade ICU and transplant facilities in government hospitals with dedicated Transplant ICUs (TICUs) and operation theatres, adopt advanced preservation technology like hypothermic/normothermic machine perfusion, and standardize organ procurement and transport protocols to reduce delays and wastage.
  • Fast-track BSD committee approvals through digital systems and trained personnel, and simplify medico-legal procedures for trauma cases to enable timely organ retrieval.
• Financial Support and Policy Reforms: Include liver and heart transplants under Ayushman Bharat, covering lifelong immunosuppressant costs, along with increased funding for transplant programs in government hospitals, especially for costly procedures like lung transplants.
  • Provide a subsidy for immunosuppressant drugs and performance-linked incentives for transplant teams to reduce patient burden and boost motivation.
• Addressing Manpower Shortages: Adopt recruitment and retention policies for transplant specialists (including surgeons, nephrologists, intensivists) and reduce frequent transfers to ensure program continuity.
  • Specialized training programs for organ retrieval, transplantation, and post-op care, with collaborations with AIIMS and medical colleges to expand transplant education.
• Promoting Research and Ethical Practices: Invest in bioengineered organs, xenotransplantation, and AI-driven organ matching, while developing ethical guidelines for equitable organ allocation and transparent consent processes.
  • Promote public-private partnerships to drive innovation in transplant technology.
• Emphasising Broader Benefits: A robust organ and tissue transplant ecosystem can boost medical tourism, enhance India’s soft power, promote inter-state coordination through efficient sharing networks, and strengthen the health budget by generating revenue and reducing long-term healthcare costs.
• Strengthening Public Awareness: Launch nationwide awareness campaigns using social media, TV, and celebrity endorsements, along with school and college education, community engagement with survivor and donor family testimonials, and partnerships with religious leaders to promote organ donation and dispel myths.
  • Introduce public recognition initiatives like certificates, plaques, and memorials to honour donors and encourage greater participation.

Conclusion

India’s organ transplantation crisis demands urgent reforms—boosting infrastructure, funding, and awareness while addressing ethical and procedural gaps. Expanding Ayushman Bharat coverage, incentivizing specialists, and leveraging technology can bridge the demand-supply gap. A multi-stakeholder approach is vital to save lives and build an efficient, ethical transplant ecosystem.