Why we need to focus on the gender disparity in organ transplantation

Social Justice & Health Governance · 16 September 2026 · Based on The Hindu (original report)

2-minute summary

Recent data from the National Organ and Tissue Transplant Organization (NOTTO) reveals a profound gender disparity in India's organ transplantation ecosystem. Between 2019 and 2023, women constituted 63.8% of living organ donors, whereas men made up 69.8% of the transplant recipients. This imbalance is driven by deep-rooted sociocultural norms, economic dependencies, and patriarchal family structures. Women, particularly wives (91% of spouse donors) and mothers (73% of parental donors), are socially conditioned to prioritize family welfare, often leading to voluntary or coerced bodily sacrifice. Conversely, men are frequently shielded from donating due to their status as primary economic breadwinners, as major surgery poses perceived financial risks to the household. This systemic skew raises critical ethical concerns regarding genuine autonomy, informed consent, and gender justice in healthcare access, highlighting the urgent need for structural reforms, gender-sensitive counseling, and a stronger push toward deceased (cadaveric) organ donation.

Why it's in the news

Data released by the National Organ and Tissue Transplant Organization (NOTTO) for the 2019-2023 period highlights a stark gender gap in India, where nearly two-thirds of living organ donors are women, while over two-thirds of the recipients are men.

Facts to remember

• Between 2019 and 2023, data from NOTTO reveals that women constituted 63.8% of living organ donors while men made up 69.8% of transplant recipients.
• NOTTO registry data analyzed out of 56,509 living organ donations showed women accounted for 36,038 donations but only received 17,041 transplants.
• Organ transplantation in India is regulated under the Transplantation of Human Organs Act (THOA) of 1994, which was amended in 2011.
• The National Organ Transplant Programme (NOTP) aims to promote deceased organ donation, build a procurement network, and maintain a national registry.
• The World Health Organization formulates guiding principles on human cell, tissue, and organ transplantation emphasizing voluntary, unpaid donation and equity.

Background and context

Organ transplantation in India is regulated under the Transplantation of Human Organs Act (THOA), 1994 (amended in 2011), which criminalized commercial dealings in organs and established a framework for living and deceased donations. Due to a historically low rate of deceased (cadaveric) organ donations in India, the country relies heavily on living donors, who must be 'near relatives' (spouse, siblings, parents, children, grandparents, grandchildren) to prevent commercial exploitation. However, this reliance on familial living donors has inadvertently exposed deep-seated gender imbalances. Sociological studies and clinical registries have consistently shown that women bear a disproportionate burden of donation, reflecting broader patriarchal structures where women's health and bodies are often deprioritized relative to male breadwinners.

Constitutional provisions

• Article 14 — Guarantees equality before the law, which is compromised when systemic socio-cultural pressures deny women equal protection of their health and bodily autonomy.
• Article 15 — Prohibits discrimination on grounds of sex; systemic gender disparities in medical procedures like organ transplantation reflect indirect discrimination arising from societal roles.
• Article 21 — Guarantees the Right to Life and Personal Liberty, which encompasses the right to health, bodily integrity, and free informed consent without familial coercion.
• Article 39(e) — Directive Principle directing the State to ensure that the health and strength of workers, men and women, are not abused.

Committees and reports

• NOTTO Registry Data Analysis — Revealed that out of 56,509 living organ donations over five years, women accounted for 36,038 donations, but only received 17,041 transplants, highlighting the massive gender gap.

Government schemes

• National Organ Transplant Programme (NOTP) — Aims to promote deceased organ donation, establish a network for organ procurement, and maintain a national registry to reduce reliance on living donors.

International organisations

• World Health Organization (WHO) — Formulates the 'WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation', emphasizing voluntary, unpaid donation and equity in access.

Mains practice: The stark gender imbalance in living organ donations in India is a reflection of deep-seated socio-economic vulnerabilities rather than mere altruism. Analyze.

Recent data from the National Organ and Tissue Transplant Organization (NOTTO) reveals a troubling gender gap: between 2019 and 2023, women constituted 63.8% of living organ donors, while men comprised 69.8% of transplant recipients. This imbalance highlights that organ donation is not merely a medical event but a social phenomenon shaped by gendered power dynamics.

**Socio-Economic Drivers of the Gender Disparity:**

• **Patriarchal Caregiving Expectations:** Traditional gender roles position women as natural caregivers and self-sacrificing figures. Mothers comprise 73% of parental donors, and wives make up 91% of spouse donations, reflecting an internalized or socially enforced duty of bodily sacrifice.

• **Economic Dependency and Breadwinner Logic:** Men are predominantly viewed as the primary financial providers. The prospect of a male family member undergoing major surgery, facing recovery periods, or losing income is seen as an unacceptable economic risk, shifting the donor burden to women, who are often viewed as economically expendable.

• **Asymmetry in Healthcare Access:** Families are often more willing to invest financial resources in saving a male relative's life than a female relative's, leading to fewer women being registered as recipients.

**Ethical and Policy Implications:**

• **Compromised Autonomy:** The thin line between voluntary altruism and familial coercion is frequently blurred, challenging the bioethical principle of informed consent.

• **Systemic Inequity:** A healthcare system relying on the disproportionate physical sacrifice of one gender to sustain another violates the principles of distributive justice.

**Way Forward:**

To address this, India must transition from living to deceased (cadaveric) donations by strengthening infrastructure under the National Organ Transplant Programme. Furthermore, hospital Authorization Committees must mandate independent, gender-sensitive psychiatric counseling to detect subtle coercion, and financial support systems must be introduced to mitigate the loss of income for male donors, ensuring equity in both donation and access to care.

Prelims practice questions

Q1. With reference to the National Organ and Tissue Transplant Organization (NOTTO) in India, consider the following statements: 1. It is an apex organization established under the Ministry of Health and Family Welfare. 2. It was set up under the provisions of the Transplantation of Human Organs (Amendment) Act, 2011. 3. It maintains a national registry of donors and recipients to facilitate organ procurement and distribution. Which of the statements given above are correct?

1. 1 and 2 only
2. 2 and 3 only
3. 1 and 3 only
4. 1, 2 and 3

Answer: D. NOTTO is the apex national body for organ procurement, distribution, and registry maintenance. It functions under the Directorate General of Health Services, Ministry of Health and Family Welfare, and was established following the mandate of the Transplantation of Human Organs (Amendment) Act, 2011.

Q2. Under the Transplantation of Human Organs Act (THOA) in India, who among the following is NOT automatically classified as a 'near relative' for living organ donation?

1. First Cousin
2. Spouse
3. Grandchild
4. Sibling

Answer: A. According to the Transplantation of Human Organs Act, 'near relatives' include spouse, parents, siblings, children, grandparents, and grandchildren. First cousins do not automatically fall under the definition of 'near relatives' and require special permission from the state-appointed Authorization Committee to prevent commercial dealings.

Q3. Which of the following best describes the primary objective of the National Organ Transplant Programme (NOTP) in India?

1. To ban living organ donations entirely in favor of artificial organ alternatives.
2. To promote deceased organ donation and establish a network for organ procurement to reduce reliance on living donors.
3. To subsidize the cost of private organ transplant surgeries for all citizens.
4. To mandate compulsory organ donation for all citizens post-death.

Answer: B. The primary objective of the National Organ Transplant Programme (NOTP) is to promote deceased (cadaveric) organ donation, create a national network for procurement and distribution, and maintain a registry, thereby reducing the heavy ethical and physical burden associated with living organ donations.

Revision flashcards

• What is the gender split in living organ donors vs. recipients in India (2019-2023)? Women constitute 63.8% of living organ donors, while men constitute 69.8% of transplant recipients.
• What percentage of spouse-to-spouse organ donations in India are made by wives? Wives account for 91% of all organ donations between married couples.
• Which statutory act regulates organ donation and transplantation in India? The Transplantation of Human Organs Act (THOA), 1994 (amended in 2011).
• What is NOTTO and under which ministry does it function? National Organ and Tissue Transplant Organization; it functions under the Ministry of Health and Family Welfare.
• Why does the economic role of men as 'breadwinners' affect organ donation patterns? Families avoid male donation to prevent financial risks from surgery and recovery time, often shifting the donor burden to women who are perceived as economically expendable.