Why does India have so few organ donors?

India's demand for organ donation surpasses its supply and its rate of deceased organ donors stands below one donor per million population. That's staggeringly low — especially when compared with countries like the United States and Spain whose rates of deceased organ donors are among the highest in the world at over 40 donors per million people.

In India, a huge gap still exists between those requiring transplants and the actual number of organs available for transplant, resulting in the death of many patients who require donated organs to stay alive.

Demand outweighs supply for organs

Doctors and transplant specialists have identified a variety of factors contributing to the shortage of organ donors, including a lack of awareness about organ donation, misconceptions surrounding the practice and infrastructural issues.

Organ transplantation in India is predominantly facilitated by living donors who agree to donate an organ — a kidney, for example — while they are still alive.

India performs the world's second-highest number of living donor transplants after the United States — but only a small number of transplants in the South Asian nation are from deceased donors.

"In 2019, 88% of 9,751 kidney transplants and 77% of the 2,590 liver transplants performed in India were from living donors," Sunil Shroff, from the Mohan Foundation, a not-for-profit organization promoting organ donation and transplantation, told DW.

"In comparison, only 36% of kidney and 19% of liver transplants performed globally are from living donors."

Could India's soaring road deaths increase donor rates?

Every year, around 150,000 people die on India's roads, which translate on average to over 1,000 collisions and more than 400 road deaths every day, according to road transport figures.

Organ donation involves harvesting the organs belonging to a deceased donor — heart, liver, kidneys, intestines, eyes, lungs and pancreas, for example — and transplantng them into another person who needs them to live. A deceased donor, also known as a cadaver, can save the lives of up to nine people.

Only a small number of transplants in India are from deceased donors

But health professionals do not always feel comfortable broaching the topic of organ donation with the relatives of recently-departed family members.

"Doctors are unwilling to ask for deceased donor organs. There is no incentive and also a fear of reprisals," Dr Samiran Nundy, a liver transplant surgeon at New Delhi's Sir Ganga Ram Hospital, told DW.

India's infrastructure issues

Even if more people were willing to become organ donors, not all hospitals are equipped to carry out the process of organ transplantation and retrieval.

There are only 250 hospitals that have registered with India's National Organ and Tissue Transplant Organization (NOTTO), which coordinates the country's organ transplant program.

That's one fully-equipped hospital for every 4.3 million citizens. Transplant centers are even sparser in India's rural areas.

Tertiary care corporate hospitals account for the bulk of organ donations, while public sector hospitals contribute less than 15%, according to the recent article "Progress with Deceased Donation in India" written in the Indian Transplant Newsletter.

"The true potential for deceased donation in India lies in public sector hospitals, where a large number of head trauma cases are admitted due to their medico-legal implications," the study said.

"If each state had one nodal hospital focused on deceased donation, it could improve the organ donation rate and provide more affordable transplant options to patients from the less affordable class."

A lack of awareness about organ donation contributes to a shortage of organ donors across India

The Mohan Foundation's Sunil Shroff also pointed out that the current health system limits the health benefits of donated organs to Indians and foreigners with the ability to pay and allows private hospitals to profit without contributing much to the system.

"Indigent Indians who can potentially donate large number of organs have little or no hope of ever receiving lifesaving transplants, and there is little investment in developing the necessary infrastructure and expertise to support deceased donation in government hospitals," he said.

The way forward

Organ donations globally reached almost 130,000 in 2020, with the Americas and Europe making up the largest proportion of global kidney transplants, while Africa has the lowest proportion of such transplants.

Although the Indian government has been pushing for organ donation, there is still a long way to go. Many experts point out that there have been no sustained advertising campaigns to raise awareness among citizens and medical professionals. 

In March, Indian Prime Minister Narender Modi during his monthly radio broadcast appealed to people to opt for organ donation. He said that his government was working on a uniform policy that would encourage and simplify organ donation. 

India is among the countries with the least amount of money spent on public health, according to the latest national health profile. New Dehli hopes to invest 2.5% of the country's GDP into health care by 2025 — but that is still less than the global average of about 6%.

"Organ donation in the country will only get better by more public and doctor education and praising donor families," said Nundy.

Edited by: Keith Walker