A National Review Meeting on Organ Transplantation Activities in Government Hospitals, convened virtually by the National Organ & Tissue Transplant Organization (NOTTO) under the Ministry of Health & Family Welfare, has exposed systemic challenges hindering organ donation and transplantation across India. The meeting, held on June 4, 2025, brought together key stakeholders from government hospitals nationwide to assess the current landscape and devise a strategic roadmap to bridge the critical demand-supply gap for organs.
The executive summary of the meeting highlights severe deficiencies in infrastructure, human resources, administrative processes, financial support, and public awareness. These factors collectively contribute to the “sub-optimal contribution of the public sector to national organ transplant numbers,” despite the vast potential of government hospitals, particularly in trauma and critical care settings.
Key Challenges Identified
The Director, NOTTO, led discussions that revealed a troubling disparity: while some government institutions like IKDRC Ahmedabad and PGIMER Chandigarh perform a high volume of transplants, many others with licenses and physical infrastructure, such as GB Pant Hospital in New Delhi, conducted “either nil or very few” deceased donations. The high-volume centers are also operating at maximum capacity, limiting further expansion.
The consolidated challenges include:
Infrastructural Deficiencies
A pervasive lack of dedicated transplant operation theatres (OTs) and Intensive Care Units (ICUs), insufficient ICU beds for both potential brain-stem dead (BSD) donors and recipients, and the absence of in-house Human Leukocyte Antigen (HLA) typing labs, leading to significant delays and logistical hurdles.
Human Resource & Manpower Constraints
A critical shortage of specialized transplant surgeons, physicians, anesthetists, neurosurgeons, intensivists, and particularly trained Transplant Coordinators. Frequent transfers and attrition of trained staff further disrupt program continuity.
Administrative & Procedural Hurdles
Delays in obtaining formal BSD Committee approvals, complex medico-legal procedures for trauma cases (a major pool of donors), and poor coordination among medical institutions.
Financial & Policy Gaps
Insufficient funding to initiate or sustain complex transplant programs (e.g., lung transplantation), the high and often lifelong cost of immunosuppressant drugs (with limited scheme coverage), lack of formal financial and non-financial incentives for transplant teams, and the non-inclusion of costly liver and heart transplantations in major central health schemes like Ayushman Bharat.
Awareness & Sensitization Issues
Low motivation and awareness among both the public and hospital staff regarding organ donation, underscoring a pressing need for enhanced Information, Education, and Communication (IEC) activities.
Strategic Recommendations for a Multi-pronged Approach
Participants proposed a set of recommendations to revitalize the organ transplantation program in government hospitals:
Strengthening Infrastructure
Establish more dedicated transplant Centers of Excellence, increase ICU/critical care bed capacity, mandate organ retrieval facilities in all government medical colleges and trauma centers, and provide financial support for in-house HLA laboratories.
Policy & Financial Interventions
Crucially, a strong recommendation was made to comprehensively include liver and heart transplantation, along with lifelong immunosuppressant costs, under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) scheme. Furthermore, introducing performance-based financial and non-financial incentives for transplant teams was urged. Enhancing financial support under the National Organ Transplant Program (NOTP) for facility upgrades and new center establishment is also critical.
Manpower Development & Training
Implement specialized, structured training programs for all relevant medical and support staff, including hands-on training for surgeons using soft cadavers, and standardized modules for BSD identification. A significant increase in Transplant Coordinator training programs is also a priority.
Improving Coordination & Processes
Explore shared surgeon pools to optimize skills, streamline medico-legal processes with law enforcement, consider Public-Private Partnerships (PPPs) for complex transplants, and encourage more in-house donations within established centers.
Awareness & Sensitization
Launch broad-based awareness campaigns within hospitals and communities, utilize new methods like education system integration, highlight positive outcomes from government institutions, and sensitize police and transport stakeholders for smoother organ transport.