Daijiworld Media Network – New Delhi

New Delhi, Aug 14: Organ donation can give a fresh lease of life to patients awaiting transplants. But once an individual pledges to donate organs, or a family gives consent after death, an important question remains — who decides which patient receives the donated organ?

In India, organ allocation is governed by guidelines issued through the National Organ and Tissue Transplant Organisation (NOTTO), with the criteria varying depending on the organ or tissue involved. Medical compatibility, urgency, waiting-list status and other factors are taken into account rather than simply giving the organ to the patient who has waited the longest.

For kidneys donated after death, allocation is carried out through the applicable kidney allocation system and waiting list. Blood-group compatibility is an important consideration, while human leukocyte antigen (HLA) matching also plays a significant role.

Dr Deepesh V, Consultant - Nephrology and Renal Transplant Physician at Manipal Hospital Kanakapura Road, said that when a deceased-donor kidney becomes available, patients at the top of the waiting list may be called for HLA compatibility tests.

If the first eligible patient is compatible and medically fit to receive the kidney, it may be allocated to that patient. If the patient is not eligible, the organ is considered for the next suitable recipient on the list.

Not necessarily. Organ allocation depends on the organ involved and a range of medical factors.

For heart, lung and liver transplants, factors such as waiting-list status, blood-group compatibility, medical urgency and the size of the donor and recipient are considered. A super-urgent category is also available for patients who meet specified medical criteria, allowing them to receive organs out of the usual order.

Unlike kidney transplantation, HLA matching is generally not applied in the same way for heart, lung and liver allocation.

A donated organ is a scarce and time-sensitive resource. The allocation system therefore seeks to balance medical compatibility, urgency and the likelihood of a successful transplant while ensuring that organs are distributed through a transparent and fair process.

India recorded 20,138 organ transplants in 2025, its highest number to date. However, the demand remains substantially higher, with tens of thousands of patients requiring kidney and liver transplants.

Dr Saurabh Singhal, Senior Consultant and Director, Centre for Liver-GI Diseases and Transplantation at Aakash Healthcare, said the rise in transplant numbers reflects improvements in infrastructure, awareness and coordination between hospitals.

He noted that despite the progress, India is still meeting only a fraction of the actual demand for donated organs.

Doctors say misconceptions surrounding organ donation remain a major barrier. Religious and cultural concerns can sometimes make families hesitant to donate, even though major faiths practised in India support organ donation.

Dr Bipin Vibhute, Consultant and Program Director, Liver Transplant and HPB Surgery at Jupiter Hospital, Pune, said families often hesitate because they lack accurate information about the process and the impact of donation.

Misconceptions also exist around living organ donation, including concerns about fertility and reproductive health.

Dr Vineet Malhotra, Head of Urology at VNA Hospital, said such fears need to be addressed through accurate medical information. He stressed that organ transplantation is aimed not only at extending life but also at restoring the recipient's quality of life.

Dr Archana Dhawan Bajaj, Founder and Director of The Nurture IVF Centre, also highlighted the importance of ensuring that women are included in conversations about living donation and that assumptions about their health or family responsibilities do not prevent them from being considered as potential donors.

Ultimately, organ donation is not simply about deciding who needs an organ the most. Each transplant involves a structured process based on medical compatibility, urgency, waiting-list considerations and regulatory guidelines. The aim is to ensure that every viable donated organ reaches an appropriate recipient through a fair and medically sound system.