India has emerged as one of the world’s largest centres for organ transplantation, ranking third globally in the number of transplants performed. Yet despite this progress, the country is still able to meet only a small portion of its actual need for life-saving organs.
A study published in The Lancet Regional Health – Southeast Asia highlights the enormous gap between demand and availability. Researchers found that India’s transplant system in 2021 fulfilled only 7.2% of the estimated need for kidney transplants, 1.5% for liver transplants, 1.2% for lung transplants and just 0.2% for heart transplants.
The figures reveal a major challenge: performing more transplants does not necessarily mean that enough patients on waiting lists are receiving the organs they need.
India Recorded More Than 20,000 Transplants in 2025
India’s transplant programme reached a new milestone in 2025, with 20,138 organ transplants performed during the year.
However, the composition of these procedures exposes another major weakness in the country’s transplant ecosystem. As many as 16,612 transplants involved living donors, while only 3,526 came from deceased donors.
This means roughly 82% of India’s transplants depended on living donors, most commonly family members.
Dr Chetan Kalal, DM Hepatologist and Liver Transplant Specialist at Saifee Hospital, Mumbai, explains that agreeing to donate an organ is only the beginning of the process.
A potential donation can become an actual transplant only when hospitals successfully identify an eligible donor, establish brain-stem death according to medical protocols, communicate effectively with the family and activate the organ-retrieval system quickly enough.
The Demand for Organs Is Far Greater Than the Supply
The Lancet analysis shows just how large the mismatch is.
In 2021, India’s estimated requirement included approximately:
- 125,894 kidney transplants
- 84,542 to 1.85 lakh liver transplants
- 83,841 heart transplants
- 11,253 lung transplants
The actual number of procedures was nowhere near these estimated requirements.
The situation could become even more challenging in the coming years. By 2040, annual demand is projected to reach around 143,722 kidney, 210,649 liver, 95,711 heart and 12,846 lung transplants.
An ageing population and the growing burden of chronic diseases are expected to drive much of this increase.
Transplants Remain Concentrated in a Few Regions
Access to transplantation is also highly uneven across India.
Five major regions — Tamil Nadu, Delhi-NCR, Kerala, Maharashtra and Telangana — account for approximately 80% to 96% of transplant procedures, despite representing only around 29% of the country’s population.
This concentration highlights the shortage of advanced transplant infrastructure and specialised medical teams in many other parts of India.
Patients living far from major transplant centres can face additional financial, logistical and medical challenges while seeking treatment.
Is Lack of Donors Really the Biggest Problem?
Public willingness to donate organs is often considered one of the main obstacles to transplantation. However, specialists say the problem goes much deeper.
More than 2.58 lakh people reportedly pledged to donate their organs in 2025, demonstrating considerable public willingness to support organ donation.
The bigger challenge is converting those pledges into actual donations.
For a deceased donation to take place, several steps must work correctly. A potential donor needs to be identified inside a hospital, brain-stem death must be appropriately assessed and certified, the family must be counselled, and the retrieval and allocation network must act within a limited window.
If any link fails, a potentially life-saving donation may never reach a patient.
Hospital Infrastructure Is a Major Part of the Problem
Dr Kalal believes India’s deceased-donation shortage should therefore not be viewed solely as a question of public awareness or generosity.
Limited transplant facilities, a shortage of trained professionals, delays in organ retrieval and allocation, financial constraints and unequal access to specialised healthcare all contribute to the shortage.
Social and cultural factors can further influence decisions around organ donation.
India’s deceased organ donation rate also remains dramatically lower than that of leading transplant nations. According to the figures cited, India’s rate is around 70 times lower than Spain’s and 58 times lower than the United States’.
Women Are More Likely to Donate but Less Likely to Receive
Another significant imbalance can be seen in the gender distribution of transplantation.
Women make up a large proportion of living donors, particularly within families. However, they represent a considerably smaller share of transplant recipients.
Women accounted for only about 36.8% of kidney, 30.4% of liver and 23.5% of heart transplant recipients, according to the data cited.
This disparity raises important questions about equal access to transplantation and how decisions about organ allocation and treatment are made.
Dr Anil Ganju, Consultant – Nephrology at Bhailal Amin General Hospital, Vadodara, says addressing India’s transplant shortage requires more than simply increasing awareness. He points to the need for simpler legal procedures, stronger organ-transport systems, transparent allocation mechanisms and greater coordination between different parts of the healthcare system.
Liver Patients Face an Especially Urgent Situation
The shortage can be particularly dangerous for people suffering from severe liver disease.
Patients with kidney failure can often rely on dialysis for an extended period while waiting for a transplant. There is no equivalent long-term replacement therapy for a severely failing liver.
India performed 5,154 liver transplants in 2025, but patients with rapidly progressing liver failure may have very little time to wait for a suitable organ.
This makes timely identification and retrieval of deceased-donor organs especially important for patients with advanced liver disease.
Better Data Could Help Identify Where Donations Are Lost
Experts say improving India’s transplant numbers requires closer examination of what happens between a potential donor’s death and the eventual transplantation of an organ.
Dr Kalal argues that states should track the entire deceased-donation pathway rather than simply publishing the final number of donors.
This could include monitoring:
- How many potentially eligible ventilated deaths occurred
- How many patients were evaluated for brain-stem death
- How many were formally certified
- How many families were approached
- How many families agreed to donation
- At which stage potential donations were lost
Such data could reveal exactly where the system is failing and where interventions would have the greatest impact.
India Still Faces a Huge Transplant Challenge
The Lancet study’s projections suggest that the gap could remain substantial even if reforms are introduced.
Under a moderate reform scenario, kidney transplant coverage could rise to only 32.6% of projected demand by 2040, while coverage for liver, heart and lung transplants would remain below 7%.
India’s growing transplant numbers are undoubtedly a major achievement. But the figures also underline a difficult reality: the country does not simply need more transplant surgeries — it needs a stronger, more evenly distributed system for identifying donors, retrieving organs and ensuring fair access to transplantation.
Expanding specialised infrastructure, improving deceased-donation networks, strengthening hospital systems, simplifying processes and ensuring transparent allocation could be critical to reducing the enormous gap between patients waiting for organs and the organs actually available.