Geetanjali Mishra
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India’s Organ Transplant Crisis
India holds the world's third- highest total volume of organ transplants and yet only meets a minute fraction of its actual clinical demand. A pivotal research study has been published in The Lancet Regional Health Southeast Asia. The research offers the country's first comprehensive assessment of the true unmet need for organ transplantation. Also exposes the severe systemic gaps, sharp regional disparities, and deeply ingrained gender imbalance across the healthcare system.
As per the study, India needed approximately 3.9 lakh solid organ transplants, including kidneys, livers, hearts, and lungs, in the year 2021. It is believed that the rapidly ageing population, changing lifestyle patterns, and the accelerating prevalence of non-communicable and chronic end-stage diseases can shift this annual requirement to rise dramatically to 4.63 lakh by the year 2040.
While India performs the third highest number of organ transplants in the world after the US and China, the study says the gap between surgeries done and surgeries needed remains huge. A large fraction of patients with end-stage organ failure still can not receive life-saving surgical interventions.
1. Kidney Transplants: In 2021, approximately 1.26 lakh patients required a kidney transplant; still, only 7.2% of demand was fulfilled.
2. Liver Transplants: Approximately 1.85 lakh patients needed a liver transplant, and yet 1.5% received one.
3. Lung Transplants: 1.2% of 11,253 patients requiring lung transplant underwent surgery.
4. Heart Transplants: The gap between cardiac failure need and treatment left readers stunned, where 83,841 patients required heart transplants and only 0.2% of them underwent surgery.
It is believed that by 2040 this annual demand will reach up to 1.44 lakh for kidneys, 2.11 lakh for livers, 95,711 for hearts, and 12,846 for lungs.
The secretary of the Indian Society of Organ Transplantation (ISOT) and the lead author of the study, Dr. Manish R. Balwani, highlighted that we should stop counting the number and instead focus on the waitlisted patients.
Dr Balwani said, "India performs the third-highest number of transplants, but a raw number tells you nothing unless you know the size of the queue behind it." Adding more, he said, "In the US and Europe, waiting-list registries tell you exactly how many people are waiting for a transplant. We wanted to convert what doctors see every day into numbers that policymakers can act upon."
In order to calculate these figures, data have been synthesised by the research team from global burden of disease (GBD) estimates, national and regional transplant registry data, and demographic projections.
Dr. Vatsala Trivedi, the surgeon who performed India's first successful cadaveric kidney transplant in 1997 following the enactment of the Transplantation of Human Organs Act, reiterated the imperative for policy reform and also commented independently on this research study.
Dr. Trivedi said, "There is indeed a wide gap between demand and supply of organs across India." She also stated that national healthcare strategy must urgently intensify solid organ transplant services guided by concrete epidemiological facts rather than informal perceptions.
The Lancet study has unwrapped several critical insights that differentiate the organ failure landscape of India from Western nations.
Liver demand surpasses kidney demand: India, in contrast with other developed nations, where end- stage renal disease drives the highest transplant demand, exhibits a higher overall need for liver transplants than kidney transplants. Research gives credit to India's soaring burden of Chronic diseases, including non-alcoholic fatty liver diseases, viral hepatitis and alcoholic liver diseases for this anomaly.
Extreme Regional Gap: The study reveals a severe geographical inequity. Only 5 states of India, including Maharashtra, Tamil Nadu, Delhi-NCR, Kerala, and Telangana, that represents only about 29% of the total Indian population, are accountable for 80% to 96% of all the transplant activity in India.
Dr. Vivek B. Kute, the Treasurer of ISOT and co-author of the study, underscored the stark implications of this spatial distribution and said, "The geographic concentration was the most striking finding. Whether you live or die of organ failure in India depends heavily on your pincode."
In India, the transplant program remains overwhelmingly reliant on living donor organ donation. In India, approximately 82% of transplant surgeries involve a living donor who is usually a close family relative or friend. This data shows the persistent deficiency in deceased donation networks and public awareness.
Furthermore, data shows the gender disparities in both organ receipt and donation. In India, almost half of the living people with chronic organ failure are women. Also, they are the ones stepping up to donate more. Most of the living donors in India are women who are giving organs to male family members. Still, they received just 36.8% of kidney transplants, 30.4% of liver transplants, and 23.5% of heart transplants.
The study argues to build a proper national waitlist, push deceased organ donation, strengthen rural hospitals, and tackle the social bias that leaves women behind.
Disclaimer: This article is based on research published in The Lancet Regional Health Southeast Asia and expert interviews. The content on TheHealthSite.com is for informational purposes only and does not constitute medical advice. For diagnosis, treatment, or guidance related to organ donation and transplantation, please consult a qualified medical professional.