A Union Health Ministry report prepared by the National Organ and Tissue Transplant Organisation highlights serious shortcomings in India’s organ transplantation programme.
About Organ transplantation
- Organ transplantation is a surgical procedure that involves removing an organ, tissue, or group of cells from one person (the donor) and implanting it into another person (the recipient), or relocating it within the same individual.
- Commonly transplanted organs include the kidney, liver, heart, lungs, pancreas, and intestines.
National Organ and Tissue Transplantation Organisation (NOTTO)
- It is a National level apex organization set up under the Directorate General of Health Services, Ministry of Health and Family Welfare.
- Headquarters: New Delhi.
- Objective: To facilitate coordination and networking in organ transplantation activities.
- Function:
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- Lay down policy guidelines and protocols.
- Compile and publish registry data.
- Maintaining the waiting list of terminally ill patients requiring transplants.
- Consultancy support on the legal and non-legal aspects of donation and transplantation.
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- Core problems include infrastructure gaps, inadequate funding, shortage of trained professionals, and delays in regulatory processes.
Key Findings
Severe gap between need and capacity
- Only 13,476 kidney transplants performed in 2024–25 (vs recommended 1,00,000).
- Government hospitals lack capacity to meet demand.
Infrastructural deficiencies
- Lack of specialised transplant Operation Theatres (OT) and Intensive Care Units (ICU).
- Existing ICUs and OTs are overburdened with general patients.
- Critical shortage of ICU beds, especially for:
- Brain-stem dead (BSD) donors.
- Post-operative transplant patients.
- No in-house Human Leukocyte Antigen(HLA) labs in many government hospitals including several AIIMS.
- Dependence on external labs causes delays and logistical challenges in the transplantation process.
Human Resource Challenges
- Shortage of specialised personnel such as Transplant surgeons, Nephrologists, Urologists, Anaesthetists, Neurologists and intensivists
- High attrition and frequent transfers disrupt transplant programme continuity.
- Lack of case-based incentives for transplant teams (surgeons, nurses, coordinators).
Procedural and Administrative Bottlenecks
- Delays in approval and formation of BSD committees whose approval is essential for deceased organ donation.
- Complex handling of medico-legal cases (especially trauma victims) discourages organ donation.
Financial Constraints
- High cost of immunosuppressants (lifelong medication). Current public schemes often cover only 1st year, leaving patients financially burdened later.
- Lack of funds in many hospitals to start or sustain high-cost procedures like lung transplants.
- Absence of financial incentives for transplant teams (surgeons, nurses, coordinators).
- Ayushman Bharat lacks coverage for Liver and heart transplants and the associated lifelong post-transplant costs
Recommendations
- Inclusion of liver and heart transplants (including lifelong immunosuppressant costs) under Ayushman Bharat PMJAY.
- Financial incentives for transplant teams.
- Establish in-house HLA labs in key hospitals.
- Streamline Brain-stem dead (BSD) committee formation and legal processes.
Additional Reading: AB – PMJAY
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vishal pathaniya
