Addressing Gender Disparity in Organ Transplantation: A Step Towards Inclusive Healthcare

Addressing Gender Disparity in Organ Transplantation: A Step Towards Inclusive Healthcare

By Suryavanshi IAS

Introduction

The National Organ and Tissue Transplant Organization (NOTTO) recently issued an advisory to prioritize women and relatives of deceased donors in organ transplant waiting lists. This move aims to correct the gender imbalance in organ transplantation, where women constitute a majority of living donors but a minority of recipients. While the initiative is commendable, its implementation raises ethical and procedural challenges.

This blog explores the issue from a UPSC perspective, covering:

1.    Current Scenario of Organ Transplantation in India

2.    Gender Disparity in Organ Donation & Transplantation

3.    NOTTO’s Advisory: Pros and Cons

4.    Ethical and Legal Considerations

5.    Previous Year UPSC Questions (Prelims & Mains)

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1. Current Scenario of Organ Transplantation in India

• India faces a severe shortage of organs, with a demand-supply gap of nearly 1:500,000 for kidneys alone.
• Legal Framework:
• Transplantation of Human Organs Act (THOA), 1994 – Regulates organ donation and prevents commercial trade.
• NOTTO (National Organ and Tissue Transplant Organization) – Apex body for organ procurement and allocation.
• Types of Donations:
• Living Donor (Kidney, Liver lobe) – Mostly from family members.
• Cadaver Donor (Heart, Lungs, Corneas) – Requires brain death certification.

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2. Gender Disparity in Organ Donation & Transplantation

• Women as Donors:
• 63% of living donors in 2023 were women (NOTTO data).
• Cultural and societal pressures often push women to donate organs for family members.
• Women as Recipients:
• Only 24% (heart) to 47% (lung) of organ recipients are women.
• Kidney transplants: 37% women recipients.
• Liver transplants: 30% women recipients.
• Reasons for Disparity:
• Financial constraints – Women often lack independent access to healthcare.
• Social bias – Male family members may be prioritized for transplants.

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3. NOTTO’s Advisory: Pros and Cons

Pros:

✅ Corrects Historical Gender Bias – Ensures women get fair access to transplants.
✅ Encourages Cadaver Donations – Relatives of deceased donors get priority, incentivizing donations.
✅ Aligns with SDG 3 (Good Health & Well-being) – Promotes equitable healthcare.

Cons:

❌ Procedural Challenges – Current protocols prioritize medical urgency, not gender.
❌ Risk of Misuse – Could lead to "backdoor" allotments if not regulated strictly.
❌ Definition Ambiguity – Who qualifies as a "near relative"?

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4. Ethical and Legal Considerations

• Principle of Justice (Article 14, Constitution) – Should allocation be need-based or identity-based?
• Medical Ethics – Should gender be a factor over medical urgency?
• THOA Amendments – Need stricter implementation to prevent organ trafficking.

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5. Previous Year UPSC Questions (Prelims & Mains)

Prelims Questions (Last 8 Years)

Q1. Consider the following statements regarding organ transplantation in India: (2021)

1.    The Transplantation of Human Organs Act (THOA) was enacted in 1994.

2.    NOTTO is the regulatory body for organ allocation in India.

3.    Living donors can only be near relatives as per the law.

Which of the above statements are correct?
(a) 1 and 2 only
(b) 2 and 3 only
(c) 1 and 3 only
(d) 1, 2, and 3

Answer: (d) 1, 2, and 3

• Explanation: THOA was enacted in 1994, NOTTO regulates organ allocation, and living donors must be near relatives (with rare exceptions).

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Q2. Which of the following is NOT a function of NOTTO? (2019)

(a) Maintaining a registry of organ donors
(b) Allocating organs based on medical urgency
(c) Promoting cadaver donations
(d) Conducting organ transplant surgeries

Answer: (d) Conducting organ transplant surgeries

• Explanation: NOTTO does not perform surgeries; it only regulates allocation and promotes donations.

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Mains Questions

Q. Discuss the ethical and legal challenges in organ transplantation in India. How can NOTTO’s recent advisory on gender-based priority help address these issues? (GS Paper II – Governance)

• Approach:
• Highlight the organ shortage crisis.
• Discuss gender disparity in donation vs. reception.
• Analyze NOTTO’s advisory – benefits vs. risks.
• Suggest policy reforms for better implementation.

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Conclusion

NOTTO’s advisory is a progressive step towards gender equity in healthcare. However, its success depends on transparent implementation, strict monitoring, and public awareness. UPSC aspirants must understand the legal, ethical, and governance aspects of such policies, as they frequently appear in exams.

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