The National Organ and Tissue Transplant Organization’s (NOTTO) recent advisory, stating that women patients and relatives of deceased donors awaiting transplants will get priority as beneficiaries, walks the path of rewriting a gender trope.

About Organ Transplant

• Organ transplantation involves replacing a non-functioning organ, such as a heart, liver, or kidney, with a healthy one from another person. 
• Organs can be donated by living individuals, often relatives, or by deceased individuals who have consented to organ donation before or immediately after death. 
• This life-saving medical procedure, however, reveals a significant gender imbalance in India.

Gender Disparity in Organ Transplantation

• There is a striking gender skew in organ transplantation in India. 
• Women are significantly more likely to donate organs but are far less likely to receive them.
• Data from 2013-2023 shows this stark disparity: 
  • Donors: In 2023, women constituted 63% of all living organ donors. Overall, women contributed to 36,038 of the 56,509 living organ donations in India over the past five years, making up 64% of total living donations.
  • Recipients: Despite being primary donors, women comprise a much smaller percentage of organ recipients:
    • Heart transplants: Only 24% of beneficiaries.
    • Kidney transplants: Only 37% of beneficiaries.
    • Liver transplants: Only 30% of beneficiaries.
    • Pancreas transplants: Only 26% of beneficiaries.
    • Lung transplants: Only 47% of beneficiaries.
  • This data indicates a profound inequity: for every ten women who donate an organ, only four to five women receive an organ transplant.

Reasons for Gender Disparity In Organ Donation

• Patriarchal Mindset: Families often prioritise men for expensive medical treatments and organ transplants over women.
• Decision-Making Power: Due to patriarchal norms, medical decisions within households are predominantly made by male members.
• Cultural Beliefs: Traditional beliefs, such as the idea that a daughter will eventually marry into another family, lead to reduced investment in their long-term health, including organ transplants.
• Current Medical System: Organs are currently allocated based on a ‘first-come, first-served’ basis in waiting lists or on the urgency of the medical condition, without considering gender. 
  • While theoretically equitable, this system fails to counteract existing societal biases.
• Psychological Factors: Women often internalise societal pressures to prioritise their families’ needs over their own, leading them to deprioritise their own medical care, including essential treatments like organ transplants.

NOTTO’s Intervention and Proposed Solutions

The National Organ and Tissue Transplant Organization (NOTTO), India’s primary body regulating organ transplantation under the Health Ministry, has recognised this imbalance. To address this, NOTTO has issued a new advisory with significant recommendations:

• Additional Points for Women Patients: Women patients awaiting transplants will now receive additional points in the organ allocation criteria. 
  • This means that if a man and a woman have the same medical condition and are on the waiting list, the woman will be given priority.
• Priority for Deceased Donor Relatives: The advisory proposes a ‘give and take’ concept. 
  • If a family member has previously donated an organ, their family will receive priority for future organ allocation if needed.
  • This aims to incentivise organ donation and ensure fairness.

Benefits of NOTTO’s Advisory

• Social Justice: It aims to ensure equal access to healthcare for women, correcting the existing imbalance where they donate more but receive less.
• Economic Justice: Fair distribution of family resources for medical treatment will extend to women, ensuring that their health needs are addressed equally.
• Medical Ethics: It aligns with the principle that those who contribute more should also benefit more from the system.
• Increased Public Trust: A perception of fairness in the system is likely to encourage more people to come forward and donate organs.

Challenges and Concerns About NOTTO’s Advisory

• Procedural Hassles: Implementing this new prioritisation could introduce complexities into existing organ allotment protocols, which are currently based solely on health parameters.
• Lack of Clarity on ‘Near Relatives’: The advisory does not clearly define who qualifies as a ‘near relative’ for the purpose of receiving priority for future donations.
• Undefined Time Limit: There is no specified time limit for how long a family remains eligible for priority based on a past donation (e.g., if a donation was made 40 years ago).
• Risk of Corruption and Misuse: There is a significant fear that the new system could be exploited, leading to ‘backdoor’ allocations and further empowering illegal organ harvesting rackets, which unfortunately continue to operate in India.
• Ethical vs. Medical Dilemma: A crucial dilemma arises when balancing social justice with immediate medical need. 
  • For instance, if a male patient has a more severe medical condition than a female patient, prioritising the female patient solely based on gender could contradict the principle of saving the life most immediately at risk. 

Conclusion

Ensuring proper implementation under the Transplantation of Human Organs Act and widening access to the limited pool of organs is paramount. 

• Ultimately, the system must adhere to the principle of not denying anyone whose need for an organ is the greatest, based on health parameters, while also striving for social equity. 
• Striking this balance is crucial for a just and effective organ transplantation system in India.

DOWNLOAD PDF