New Delhi, Aug 2026 : Organ donation can offer a new lease of life to patients suffering from serious and often life-threatening illnesses. However, once an individual pledges to donate organs or a family gives consent after death, an important question arises: who gets the donated organ?

In India, organ allocation is governed by regulatory guidelines implemented through the National Organ and Tissue Transplant Organisation (NOTTO) and related allocation systems. Contrary to the common perception that organs are simply given to the person who has waited the longest, allocation depends on several medical and logistical factors. These include compatibility, urgency, waiting-list status and the suitability of the donor organ for a particular recipient.

Kidney allocation involves compatibility and waiting lists

For deceased-donor kidney transplantation, organs are allocated through the applicable kidney allocation system and waiting list. Blood-group compatibility is a key consideration, while human leukocyte antigen (HLA) matching can also play an important role.

Dr Deepesh V, Consultant – Nephrology and Renal Transplant Physician at Manipal Hospital Kanakapura Road, explained that when a deceased-donor kidney becomes available, patients near the top of the waiting list may be called for HLA compatibility testing.

If the first eligible candidate is found compatible and medically fit to undergo transplantation, the kidney may be allocated to that patient. If the candidate is unsuitable because of incompatibility or another medical reason, the organ can be considered for the next appropriate recipient.

This means that waiting time alone does not determine who receives a kidney. The allocation process attempts to ensure that the organ is medically suitable and can be transplanted successfully within the limited time available.

Heart, liver and lung allocation works differently

Allocation criteria vary according to the organ involved. For heart, lung and liver transplants, factors such as waiting-list status, blood-group compatibility, medical urgency and the physical characteristics of the donor and recipient may be considered.

A super-urgent category is available for patients who meet specified medical criteria. This allows critically ill patients who require immediate transplantation to be considered outside the routine sequence of the waiting list.

Unlike kidney transplantation, HLA matching is generally not used in the same manner for heart, liver and lung allocation.

Balancing urgency, fairness and medical suitability

A donated organ is both scarce and extremely time-sensitive. Once removed from a donor, it has a limited period during which it can remain viable for transplantation. The allocation system therefore seeks to balance medical compatibility, urgency, waiting-list considerations and the likelihood of a successful transplant.

India recorded 20,138 organ transplants in 2025, the highest number recorded in the country so far. Yet demand continues to far exceed supply, with tens of thousands of patients requiring kidney, liver and other transplants.

Dr Saurabh Singhal, Senior Consultant and Director, Centre for Liver-GI Diseases and Transplantation at Aakash Healthcare, said the growth in transplant numbers reflects improvements in medical infrastructure, public awareness and coordination among hospitals and transplant networks. However, he noted that India continues to meet only a fraction of the country's actual requirement for donated organs.

Misconceptions remain a major challenge

Doctors believe that a shortage of donated organs is not the only challenge. Misconceptions about organ donation continue to influence families' decisions.

Religious and cultural concerns can sometimes make relatives reluctant to consent to donation after death. Medical experts, however, point out that major faith traditions practised in India generally support organ donation.

Dr Bipin Vibhute, Consultant and Program Director, Liver Transplant and HPB Surgery at Jupiter Hospital, Pune, said families often hesitate because they do not have adequate information about the donation process or its potential impact on recipients.

There are also misconceptions surrounding living organ donation, including concerns about fertility and reproductive health. Dr Vineet Malhotra, Head of Urology at VNA Hospital, said such fears need to be addressed through reliable medical information and professional counselling.

He emphasised that transplantation is not merely about extending a patient's life but also about restoring quality of life and functional independence.

Dr Archana Dhawan Bajaj, Founder and Director of The Nurture IVF Centre, highlighted the need to ensure that women are equally included in discussions surrounding living donation. Medical decisions should be based on health and suitability rather than assumptions about women's family responsibilities or reproductive concerns.

A transparent process for a scarce resource

Ultimately, organ allocation is not simply a question of determining which patient "needs" an organ the most. Every transplant involves a structured medical and regulatory process designed to match a viable organ with an appropriate recipient.

The system considers compatibility, urgency, waiting-list position, medical fitness and organ-specific criteria. With organ demand continuing to rise, increasing awareness, improving donation rates and ensuring transparent allocation will remain critical to expanding access to life-saving transplantation in India.

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(The content of this article is sourced from a news agency and has not been edited by the Mavericknews30 team.)