Addressing Gender Disparity in Organ Transplantation in India

Brief Context

Recently, the National Organ and Tissue Transplant Organization (NOTTO) has issued an advisory that prioritizes women patients and relatives of deceased donors in organ transplant allocations.

Source Content

Syllabus: Issue Related To Health

Context

• Recently, the National Organ and Tissue Transplant Organization (NOTTO) has issued an advisory that prioritizes women patients and relatives of deceased donors in organ transplant allocations.

About Organ Transplant in India

• India performed over 18,900 organ transplants in 2024, ranking third globally in total organ transplants, behind only the United States and China.
  • Earlier in 2013, fewer than 5,000 transplants were performed in India.

Legal and Institutional Framework

• India’s transplantation system is governed by the Transplantation of Human Organs and Tissues Act (THOTA), 1994 (amended in 2011), which:
  • Legalizes brain-stem death for deceased donation;
  • Prohibits commercial organ trade;
  • Regulates living and deceased donations;
  • Requires authorization for unrelated donors;
• National Organ and Tissue Transplant Organisation (NOTTO): It coordinates organ allocation, maintains a national registry, and promotes awareness.
• National Organ Transplant Programme (NOTP): It establishes the State and Regional Organ Transplant Organisations (SOTTOs and ROTTOs).
  • Financial support is provided for infrastructure, training, and immunosuppressant drugs for BPL patients.
• Transplantation of Human Organs Rules, 1995: It defines procedures for donor consent, hospital registration, and composition of Authorization Committees.

Challenges

• Gender Gap in Transplantation: A British Medical Journal analysis found that between 2018–2023, women accounted for 36,038 of 56,509 living organ donations but were recipients in only 17,041 cases.
  • Decadal data from NOTTO (2013–2023) revealed that the living Donor Transplants (2023): Women made up 63% of all living donors. However, women comprised only about:
    • 24% of heart transplant recipients;
    • 47% of lung recipients;
    • 37% of kidney recipients;
    • 30% of liver recipients;
    • 26% of pancreas recipients.
• Implementation Challenges: Current organ allocation protocols prioritize recipients solely based on medical urgency, with no provision for gender-based priority.
  • Unclear definition of ‘near relatives’ and whether families of cadaveric donors since 1995 are eligible.
  • Concerns over possible out-of-turn allotments amid ongoing organ trafficking cases.
• Demand-Supply Gap: Over 100,000 patients need kidney transplants annually, but only around 13,000 are performed.
  • Deceased donor rates remain low due to cultural hesitations and lack of awareness.
• Other Concerns:
  • Infrastructure Deficiencies: Many government hospitals lack transplant ICUs, operation theatres, and HLA labs. ICU bed shortages hinder brain-dead donor maintenance.
  • Human Resource Shortage: Scarcity of trained transplant surgeons, nephrologists, and coordinators. Frequent transfers disrupt continuity in transplant programs.
  • Financial Barriers: High cost of lifelong immunosuppressants. Limited post-transplant support beyond the first year.
  • Data and Monitoring Gaps: Inconsistent reporting from hospitals. Lack of centralized tracking for donor-recipient outcomes.
  • Ethical and Legal Concerns: Instances of organ trafficking and commercial transplants still surface; Inconsistent interpretation of laws across states; Weak enforcement of penalties for violations.

Tamil Nadu: A Model State

• Tamil Nadu’s Cadaver Transplant Programme (CTP), now evolved into TRANSTAN, is a national benchmark. It was the first state to:
  • Issue detailed brain death certification guidelines;
  • Build equity into organ allocation;
  • Establish a swap transplant registry and promote machine perfusion for organ preservation.

Way Forward: Balancing Inclusion and Fairness

• The core challenge lies in ensuring inclusivity without undermining medical fairness. Implementation needs to:
  • Be participatory, involving all agencies under the Transplantation of Human Organs Act.
  • Maintain medical need as the primary criterion for allocation.
  • Safeguard against exploitation while widening access for women and donor families.

Source: TH

Further Reading: 15th Indian Organ Donation Day Ceremony