Answer

Introduction

The National Organ and Tissue Transplant Organization (NOTTO), under the Directorate General of Health Services, oversees organ and tissue procurement and allocation in India. Acknowledging the gender imbalance where women donate more but receive fewer transplants because of which NOTTO has advised prioritising women patients and relatives of deceased donors to promote fairness and address socio-cultural biases.

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Measures Introduced by NOTTO to Address Gender Imbalance

• Priority for Women Recipients: Additional points in organ allocation criteria for women patients awaiting transplants to address gender skew in beneficiaries.
  Eg: In 2023, women made up 63% of living donors but only 24–47% of recipients, depending on organ type.
• Recognition for Relatives of Deceased Donors: Priority for near relatives of deceased organ donors in the allocation process, acknowledging the contribution of donor families.
• Addressing Patriarchal Norms: Designed to counter societal patterns where women are more likely to donate but less likely to receive transplants.
  Eg: British Medical Journal’s  analysis (2018–23) – 36,038 women donated organs; only 17,041 received them.
• Inclusivity in Allocation Policy: Advisory framed as a corrective measure to rewrite gender norms in organ transplantation..
• Encouraging Awareness & Transparency: Signals institutional intent to make the process more equitable and visible, encouraging more women to register for transplants.
  

Challenges in Implementing These Changes

• Balancing Equity with Urgency: Priority for women must not override the fundamental principle of saving the most critical patient first.
  Eg: Principle emphasised – no denial to the person with greatest medical need.
• Conflict with Current Protocols: Existing organ allocation rules prioritise solely on medical urgency, not gender; legal framework under Transplantation of Human Organs Act lacks gender-based provisions.
• Ambiguity in Defining ‘Near Relatives’: Disputes over inclusion criteria could create inconsistencies in application.
• Risk of Misuse & Out-of-Turn Allotments: Potential for the system to be exploited as a backdoor entry for preferential treatment.
  Eg: Organ harvesting rackets continue to be uncovered in India.
• Administrative and verification hurdles: Implementing gender-based points in allocation will require extra verification steps to confirm donor history and eligibility, potentially slowing down an already time-sensitive process.
  Eg: Additional documentation and coordination with multiple agencies could delay transplants.
• Need for Multi-Agency Coordination: Success hinges on cooperation between hospitals, state authorities, and NOTTO, which may be challenging in India’s diverse health system.
  Eg: Advisory stresses participative process involving all implementing agencies.
  

Conclusion

Addressing gender disparity in organ transplantation needs more than intent, it requires clear definitions, transparent criteria, robust safeguards, and strong oversight. NOTTO should ensure participatory decision-making, compliance with the Transplantation of Human Organs Act, and data-driven monitoring with regular audits. Public awareness must challenge biases against women’s health, ensuring organ allocation is both inclusive and medically just.

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