Addressing Gender Disparity in Organ Transplantation in India

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