Organ donation offers a fresh lease of life for the recipient, but what occurs after the person decides to donate his/her organs or the family gives consent to do so? Whose decision is it as to which patient should be selected for the organ transplant, and is it just because he/she has waited the longest?
In India, the rules regarding organ allocation depend on the organ or tissue involved. The criteria may differ according to the organ involved, and it is NOTTO that provides all the necessary information in the form of guidelines. While for the kidney, blood group and HLA compatibility become a significant part of the selection process, the allocation of other organs, including the heart, lungs, and liver, works a bit differently.
So, who gets a donated kidney?
In the case of a deceased donor kidney, a selection process is carried out with regard to the respective allocation system for kidneys. In the case of kidneys, the list is made on the basis of the patients' blood groups, and a first-come, first-served basis is followed.
Dr Deepesh V, Consultant - Nephrology and Renal Transplant Physician, Manipal Hospital Kanakapura Road, says that when a deceased donor kidney is available, then certain patients who are at the top of the waiting list are sent for tests with regard to HLA compatibility.
If the first patient is compatible and able to accept the organ, it is allocated to them. If the patient cannot receive it because of blood group incompatibility, the organ moves to the next eligible patient on the list. For kidneys, both ABO compatibility and HLA compatibility are compulsory, according to Dr Deepesh.
Is it only about being first on the waiting list?
Not necessarily. Organ allocation involves several medical considerations, and the process differs depending on which organ is being offered. For heart, lung and liver transplants, allocation is based on the waiting list and blood group compatibility. There is also a super-urgent list for patients with specific urgent medical indications. Such patients can receive organs out of turn when they meet the criteria laid down by the relevant organisation.
In these cases, HLA matching is not required in the same way as it is for kidneys. Instead, factors including blood group and the size of the donor organ and recipient are considered.
Why is organ matching so carefully regulated?
A donated organ is a limited and time-sensitive resource, so the allocation system needs to balance medical compatibility, urgency and the likelihood of successful transplantation. According to Dr Deepesh, the allocation system is periodically reviewed and improved through clinical audits. The aim is to keep the process transparent and fair while ensuring that donated organs are used optimally and benefit the maximum number of patients.
The need for such a system becomes clearer when we look at India's transplant gap. The country recorded 20,138 organ transplants in 2025, its highest number to date, but more than 63,000 people need kidney transplants and around 22,000 need liver transplants, according to the other source provided.
India is doing more transplants, but the demand remains much higher
Dr Saurabh Singhal, Senior Consultant and Director, Centre for Liver-GI Diseases and Transplantation (CLDT), Aakash Healthcare, said the rise in transplant numbers reflects improvements in infrastructure, awareness and coordination. “The rise from under 5,000 transplants a decade ago to over 20,000 last year shows what better infrastructure, awareness, and coordination between hospitals can achieve,” he said. However, he added that the country is still meeting only a fraction of the actual need.
This shortage is one of the reasons awareness around organ donation remains important. Even with improvements in the transplant system, there are still far more patients waiting for organs than there are organs available.
Do myths still stop families from donating organs?
Doctors say misconceptions remain one of the major barriers to organ donation. Religious and cultural concerns can sometimes make families hesitant, even though the source notes that no major religion in India prohibits organ donation.
Dr Bipin Vibhute, Consultant and Program Director, Liver Transplant and HPB Surgery, Jupiter Hospital, Pune, said families often hesitate because they do not have the right information. “Every major faith practised in India supports organ donation as an act of compassion,” he said, adding that once families understand this, the conversation can change.
What about myths around fertility and organ donation?
Some misconceptions also relate to the health of living donors. One concern is that donating an organ, particularly a kidney, could affect fertility or reproductive health.
Dr Vineet Malhotra, Head of Urology, VNA Hospital, said such fears need to be addressed with accurate information.
“Organ transplantation is not just about extending life; it is about restoring quality of life,” he said, while also stressing that concerns about organ donation affecting masculinity or reproductive health have no scientific basis.
Dr Archana Dhawan Bajaj, Founder and Director, The Nurture IVF Centre, also highlighted the need to include more women in conversations around living donation, saying that assumptions about women's health and family responsibilities can sometimes mean potential donors are never approached.
Organ donation is not simply about deciding who needs an organ the most. Behind every transplant is a structured process involving medical compatibility, waiting lists, urgency, regulatory guidelines and transplant teams. As Dr Singhal put it, “We need sustained public messaging that treats organ donation as routine and not extraordinary.”
For a donor family, the decision can come at an extraordinarily difficult moment. But understanding what happens afterwards can also show how carefully that gift is handled. The aim is to ensure that every viable donated organ reaches an appropriate recipient through a system designed around medical need, compatibility and fair allocation.
Disclaimer: Tips and suggestions mentioned in the article are for general information purposes only and should not be construed as professional medical advice.
World Organ Donation Day: Giving purpose to life, organ transplant changes fate of recipients
