Organ Donation in India & NOTTO’s Advisory on Women

What is NOTTO?

• National Organ and Tissue Transplant Organisation (NOTTO):
  • Apex central body under Ministry of Health & Family Welfare.
  • Functions: coordination, regulation, maintaining waiting lists, allocation of organs, and standardising guidelines.
  • Works under Transplantation of Human Organs & Tissues Act (THOTA), 1994.
  • Each hospital engaged in organ retrieval or transplantation must link with NOTTO.

Relevance : GS 2(Governance , Health)

Recent NOTTO Advisory (2024–25)

• Issued a 10-point advisory to States & transplant centres.
• Key gender-related measure:
  • Women patients and relatives of deceased donors will get priority in organ allocation.
  • Aim: address gender disparity in organ donations and transplants.
• Other measures in advisory:
  • Create permanent posts for transplant coordinators in transplant/retrieval hospitals.
  • Develop organ retrieval facilities in all trauma centres.
  • Register trauma centres as retrieval centres.
  • Train emergency responders/ambulance staff to identify potential deceased donors (road accidents, strokes).

Why Women Were Prioritised? – The Gender Disparity

• Data (2019–2023, NOTTO):
  • 63.8% of all living organ donors = women.
  • 69.8% of recipients = men.
  • Numbers:
    • Donations: 56,509 total → 36,038 by women.
    • Recipients: only 17,041 women received organs vs 39,447 men.
• Pattern:
  • Women disproportionately act as donors (often for husbands, sons, brothers).
  • But when women need organs, they are less likely to receive them.
• Causes of disparity:
  • Socio-cultural factors:
    • Sacrificial role of women in families → more likely to donate.
    • Male health seen as economic priority → men given preference for transplants.
  • Financial constraints: families hesitate to fund transplant for women.
  • Medical neglect: women’s health needs deprioritised in households.

Legal Framework Governing Organ Donation

• Transplantation of Human Organs Act (THOA), 1994
  • Recognised organ donation from living donors & brain-dead donors.
  • Penalises commercial sale/purchase of organs → imprisonment + fines.
• 2011 Amendment:
  • Included donation of tissues (corneas, skin, bones, heart valves).
• Implementation:
  • NOTTO → national apex body.
  • ROTTO → Regional Organ & Tissue Transplant Organisations.
  • SOTTO → State Organ & Tissue Transplant Organisations.

Status of Organ Donation in India

• Demand–Supply Gap:
  • ~1.8 lakh Indians develop end-stage kidney disease annually.
  • Only ~12,000 kidney transplants performed per year.
• Global comparison (WHO):
  • 1.3 lakh solid organ transplants globally annually.
  • Meets only 10% of worldwide need.
• Potential impact:
  • 1 deceased donor → can save 8 lives through organs + enhance many more through tissues (cornea, skin, heart valves).

Challenges in India

• Low awareness: Organ donation not widely discussed in families.
• Cultural/religious myths: Fear about afterlife, body mutilation.
• Gender bias: Women donors vs men recipients imbalance.
• Weak infrastructure: Lack of retrieval centres, transplant coordinators.
• Mismatch in appeals vs allocation:
  • Special appeals increase pledges.
  • But allocation is still through waiting list priority → no direct transfer to person appealed for.

Why NOTTO’s Step is Significant

• Corrective measure: Recognises systemic bias against women in receiving organs.
• Equity in healthcare: Moves towards gender-just allocation.
• Symbolic value: Sends a strong public message that women’s health is equally important.
• Encouragement for donors: Families may feel more reassured that female donors (or their relatives) will also benefit if needed.

Way Forward

• Policy reforms:
  • Enforce NOTTO’s advisory at State & hospital level.
  • Monitor gender-disaggregated data on donors & recipients annually.
• Infrastructure strengthening:
  • Mandatory transplant coordinators.
  • Register trauma centres as organ retrieval hubs.
• Awareness campaigns:
  • Public messaging on importance of both genders as recipients.
  • Bust myths and cultural taboos.
• Ethical allocation:
  • Prioritisation should balance medical urgency, fairness, and gender parity.

Conclusion

India’s organ donation system suffers from a paradox: women donate the most but receive the least. NOTTO’s new advisory giving women priority in organ allocation is a landmark corrective step towards gender equity in healthcare. Yet, for real impact, this must be coupled with better infrastructure, legal enforcement, and sustained awareness campaigns to bridge the massive gap between demand and availability of organs in India