New Delhi: Only around 15 percent of registered transplant centres in India are run by the government, while the rest are in the private sector. According to the director of the National Organ and Tissue Transplant Organisation (NOTTO), high costs, infrastructural issues and a lack of awareness are among the reasons why there are more such surgeries taking place in private hospitals as compared to those run by the government.
Dr Anil Kumar told ThePrint that the overwhelming majority—around 85 percent—of the 986 registered transplant centres are privately run. While the number of organ transplants in India has not seen a significant rise in 2024 when compared to the previous year, the number of procedures carried out in private hospitals has been higher than in government hospitals, he said.
NOTTO is the apex body under the Ministry of Health and Family Welfare that oversees organ donation and transplantation activities across India.
This is also why the number of organ transplant surgeries conducted last year remained fairly consistent. According to Kumar, a tentative 18,711 organ transplants were conducted in 2024. This data has not been released yet. In comparison, according to the NOTTO website, 18,378 took place in 2023, 16,041 in 2022, 16,672 in 2021.
It was not immediately clear how many of these were conducted in government hospitals compared to private hospitals.
“This number will increase,” Dr. Kumar said. “But there are many challenges, especially in the government sector, where the numbers remain low.”
Asked about what issues plague the surgeries, he explained that while the cost of organ transplants in India is significantly lower—nearly one-tenth of what it is in Western countries like the US—it still remains an expensive treatment for many. “Cost is one factor, but we also need better infrastructure, more facilities, and trained surgeons,” he added.
Kumar emphasised that the problem isn’t limited to low donation rates. “There are infrastructure issues, particularly in government hospitals. We are working to address this under the national programme [National Organ Transplant Programme].”
Also Read: Hand transplantation surgeries to now be regulated centrally through a nationwide database
Infrastructural issues
Dr H.S. Mahapatra, director, professor and head of department of Nephrology at the Dr Ram Manohar Lohia Hospital, outlined several key challenges.
“In government hospitals, the patient load is massive, and even for routine surgeries, the waiting time is long. Transplantation is a sophisticated, planned procedure, and the availability of operation theatres is a major bottleneck,” he said.
For instance, he explained, RML Hospital currently has 22 operation theatres, none of which are exclusively designated for transplants.
“We don’t have a dedicated transplant OT. For example, we have two teams—surgery and urology. Each does a transplant once every fortnight. So we manage about four transplants a month. But if even one OT is under repair, the transplant gets cancelled,” he said. “Ideally, we should be doing transplants at least three times a week.”
Due to this limited capacity, the hospital has a sustained waiting list of around 50 patients every month. “The waiting time stretches to six months. If surgeries are delayed, the waiting list grows, and unfortunately, some patients die while waiting. That’s the reality,” Mahapatra said. Patients who cannot be accommodated are often advised to seek treatment at other hospitals.
Another major challenge is the lack of intensive care units (ICUs) tailored for transplant patients. “We require sophisticated ICUs, but currently we manage by creating temporary setups. However, by August or September, our new super-speciality block will be ready, with two dedicated transplant OTs and 20 ICUs, which will help us scale up,” Mahapatra said.
He also highlighted systemic issues, including the shortage of personnel. “In private hospitals, doctors are incentivised and can perform surgeries at any time. But in government set-ups, with limited nephrologists and surgeons, and fixed duty hours, it’s hard to manage round-the-clock transplants.”
Public awareness is another hurdle. “Many relatives of potential donors don’t understand what brain death means or what organ donation entails,” he said.
Moreover, neurosurgeons and anesthetists also need to be trained and sensitised to identify and declare brain death more proactively, which could increase the number of viable donors, according to Kumar.
Deceased donor trends
A significant gap exists between the number of patients who need organ transplants and the availability of suitable donors. One of the primary reasons for this shortage is the lack of organ donors, often due to prevailing myths and misconceptions, religious or otherwise.
Kumar explained that promoting the donation organ from deceased individuals is crucial to address the country’s massive organ demand. He highlighted the immense impact one donor can have in terms of not only saving lives but also significantly improving the quality of life for many others. “In 2024, the total number of deceased donors was around 1,128, from which approximately 3,236 organ transplants were carried out—that’s a positive sign.”
On average, he explained, one deceased donor contributes at least three organs, most commonly two kidneys and a liver or a heart. “So many of our transplants are now coming from people who donated after death.”
However, Kumar pointed out that India still needs at least 1,400 deceased donors annually to achieve even a donation rate of 1 per million population, given the country’s population of around 1.4 billion.
He emphasised that the best time to donate organs is after “brain stem death”, which occurs before the heart stops beating. At this stage, a single donor has the potential to save up to eight lives by donating vital organs such as the kidneys, liver, heart, lungs, intestines, and pancreas.
He also said that tissues like corneas, skin, bones, and heart valves can be donated as well. “Tissue donation is possible even after natural death, typically within six hours.”
According to Kumar, one-fourth of all of India’s transplants are conducted in Delhi-NCR. In 2024, it was around 24 percent of the tentative 18,711 transplants. “But out of this, only 3 percent of the transplants are from deceased donors, which is almost similar to 2023. The rest are from the living donors.”
In terms of the transplants from the deceased donors, states like Tamil Nadu, Telangana, Maharashtra, Gujarat and Karnataka have performed well, said Kumar.
Help from the government
Kumar said that NOTTO continues to run awareness campaigns to encourage more people to register as organ donors. The registration process is simple and accessible through its website, and does not require the download of any app.
He explained that NOTTO also implements the National Organ Transplant Programme (NOTP), under which the Government of India provides financial assistance to states for developing transplant infrastructure.
This includes funding for three types of facilities: transplant centres where surgeries are performed, retrieval centres that can facilitate organ donation, and tissue banks for storing cornea, skin, and bones. Organs, unlike tissues, cannot be stored and must be transplanted within a specific time frame for the best outcomes, Kumar said.
A grant is also provided for post-transplant immunosuppressant medicines to the economically disadvantaged up to Rs 10,000 per month per patient. The medicines are essential to prevent organ graft failure and improve transplant outcomes
He added that the government regularly receives proposals from state governments and medical colleges, and extends financial support to develop or upgrade transplant, retrieval, and tissue storage facilities accordingly.
Bihar, Maharashtra, Punjab, Tamil Nadu and Pondicherry are among those that have received financial support from NOTTO.
Furthermore, the Indian government runs Rashtriya Arogya Nidhi (RAN) schemes, wherein financial support of up to Rs 15 lakh for various types of organ transplants is provided to poor patients.
The Ayushman Pradhan Mantri Jan Arogya Yojana (PM-JAY) also covers cost of kidney transplant procedure for the beneficiaries.
(Edited by Sanya Mathur)
Also Read: Why nearly dozen multi-speciality private hospitals in Delhi aren’t too keen on AB-PMJAY empanelment