In 2025, India carried out a record 20,138 organ transplants, the third-highest number in the world after the United States and China. Yet if you have ever sat with a relative in a dialysis unit in Chennai or Lucknow, you know how far that is from enough. Lakhs of Indians need a kidney, liver or heart every year, and most transplants still depend on a living family member giving up a kidney or part of a liver. Organs from people who have died, which could save up to eight lives per donor, make up less than one in five transplants.
The gap is not a shortage of goodwill. More than five lakh Indians have pledged their organs online since 2023. The gap happens in hospital corridors, when a family that never discussed organ donation in India is asked to decide within hours. This guide explains how donation works, what the law says, how to pledge online through NOTTO, and, most importantly, how to make sure your family can honour your wish.
Why Organ Donation in India Needs More Donors
India's deceased donation rate has long been under one donor per million population, against roughly 40 or more per million in leading countries like Spain. Experts estimate that India needs a rate of at least 10 to 15 per million to meet demand. Commonly cited estimates of yearly need include:
| Organ or tissue | Estimated Indians needing it each year |
|---|---|
| Kidney | About 2 lakh+ |
| Cornea | About 1 lakh |
| Liver | About 50,000–80,000 |
| Heart | About 50,000 |
These figures are rough estimates, but the direction is clear. Rising rates of diabetes, high blood pressure and chronic kidney disease mean more people reach end-stage organ failure, and many die on waiting lists or remain on dialysis for years.
Where India is doing well
Deceased donation varies sharply by state. According to NOTTO data for 2025, the leading states for deceased donors were:
| State | Deceased donors (2025) |
|---|---|
| Tamil Nadu | 266 |
| Telangana | 205 |
| Karnataka | 198 |
| Maharashtra | 154 |
| Gujarat | 152 |
Tamil Nadu's success is often credited to trained transplant coordinators in ICUs, a transparent state registry, and public honours for donor families. These systems are now being copied by other states.
Types of Organ Donation in India
There are three quite different ways a person can donate, and they are often confused.
1. Living donation
A healthy adult donates while alive. Most commonly this is one kidney (the remaining kidney takes over the work), or a portion of the liver (which regrows in both donor and recipient within a few months).
- Under Indian law, living donors are usually near relatives: spouse, parents, children, siblings, grandparents and grandchildren.
- Donation by someone who is not a near relative needs approval from a hospital or state Authorisation Committee, which checks that no money is involved.
- Swap (paired) donation is allowed. If your relative's blood group does not match you, your family can "swap" donors with another family in the same situation.
2. Deceased donation after brain death
This is where one donor can help many people. Organs that can be donated include the heart, lungs, liver, both kidneys, pancreas and intestine, along with tissues such as corneas, skin, bone, heart valves and blood vessels.
Brain stem death is not the same as coma. It happens after a catastrophic brain injury, often from a road accident or a large stroke, when the brain stem has permanently stopped working. The person cannot breathe on their own and will never recover, but a ventilator can keep the heart beating and organs supplied with oxygen for a short time. That window is what makes organ donation possible.
Under the Transplantation of Human Organs and Tissues Act (THOTA), 1994, brain stem death is legal death in India. It must be certified by a board of four doctors, including a neurologist or neurosurgeon, who perform a set of tests twice, at least six hours apart.
3. Donation after natural (cardiac) death
When the heart stops at home or in a ward, major organs cannot usually be used. However, eyes (corneas) and some tissues like skin and bone can still be donated. Corneas should ideally be retrieved within 6 to 8 hours of death. Wearing glasses, having had cataract surgery, or having diabetes or blood pressure does not usually prevent eye donation.
Whole body donation is different
Donating your body to a medical college for teaching and research is a separate process, usually arranged directly with the college's anatomy department. If organs are donated first, the body may not be accepted for anatomy teaching, so check with the college if both matter to you.
What the Law Says: THOTA and Recent Reforms
India's organ donation system is governed by THOTA 1994, its 2011 amendment, and the Transplantation of Human Organs and Tissues Rules, 2014. The key points every family should know:
- Buying or selling organs is a crime. Commercial dealing in organs can lead to imprisonment of up to 10 years and fines up to ₹1 crore.
- Family consent is required for deceased donation. Even if you have pledged, doctors will ask your next of kin before proceeding.
- ICUs must ask. Hospitals are required to identify potential brain-dead donors and inform families about the option of donation.
- Registered transplant centres only. Transplants can only be done at hospitals registered under THOTA.
The 2023 "One Nation, One Policy" changes
In February 2023, the Ministry of Health and Family Welfare updated the National Organ Transplantation Guidelines:
- Domicile requirement removed: A patient can now register on the deceased-donor waiting list in any state, not just their home state.
- Age cap removed: Patients above 65 can now register to receive organs from deceased donors.
- No registration fee: States were asked to stop charging the ₹5,000 to ₹10,000 fees some had levied to join the waitlist.
Central government employees who donate an organ are also entitled to special casual leave for recovery. Check your own employer's policy if you work in the private sector.
How to Pledge Your Organs Online in India
The National Organ and Tissue Transplant Organisation (NOTTO), under the Directorate General of Health Services, runs the national pledge registry. Since 2023, pledges are Aadhaar-verified and linked with the Ayushman Bharat Digital Mission.
Step by step
- Visit the official NOTTO pledge portal (linked from notto.mohfw.gov.in).
- Enter your Aadhaar number and complete OTP verification on your linked mobile. If you have an ABHA health ID, the pledge can be linked to it.
- Choose to pledge all organs and tissues, or select specific ones such as eyes, kidneys, liver or heart.
- Add details of a family member or witness, if asked.
- Download your e-pledge certificate or donor card. Save it on your phone and give a copy to your family.
You can also call the NOTTO toll-free helpline at 1800-11-4770, which is available 24x7. Several states run their own registries (such as Tamil Nadu's TRANSTAN and Kerala's K-SOTTO), and pledges made with recognised NGOs and hospitals are also valid. Many states also offer an organ donor option when you apply for or renew a driving licence.
Who can pledge?
- Anyone above 18 can pledge independently. Minors can be donors with parental consent.
- There is no upper age limit. Donors in their 70s and 80s have given corneas, kidneys and livers. Doctors decide suitability at the time of death, not at the time of pledging.
- Having diabetes, high BP or a past illness does not automatically rule you out. Active cancer, active serious infection and some other conditions usually do, and the medical team will decide.
A pledge is not a legal contract. You can withdraw it at any time, and no one can force a donation because of a pledge.
Talking to Your Family: The Step That Actually Matters
Here is the uncomfortable truth: a pledge certificate in a drawer does not save lives. Your family's "yes" does. In Indian hospitals, the request for donation usually comes at the worst moment of a family's life, often after a sudden accident, and many families refuse simply because they do not know what their loved one wanted.
How to start the conversation
- Pick a calm moment, not a hospital visit. A news story, a film or a friend's transplant can be a natural opener.
- Be direct: "I have registered as an organ donor. If anything happens to me, I want you to say yes."
- Address common worries honestly (see below).
- Tell more than one person. Your spouse, an adult child and a sibling should all know.
- Encourage them to pledge too, so it becomes a shared family decision.
Common myths and concerns in Indian families
| Concern | The facts |
|---|---|
| "Doctors won't try to save a donor." | The treating team and the transplant team are separate. Donation is discussed only after brain death is confirmed by a four-doctor board. |
| "The body will be disfigured." | Organs are retrieved surgically with care. The body is returned for last rites, and an open-casket or traditional funeral is possible. |
| "Our religion doesn't allow it." | Leaders across major faiths in India, including Hindu, Muslim, Christian, Sikh, Jain and Buddhist traditions, have spoken in support of organ donation as an act of charity. |
| "The family will have to pay." | Costs of retrieval and related care after brain death are not charged to the donor family. |
| "Rich people will jump the queue." | Allocation follows the state and national waitlists using medical criteria such as urgency and compatibility. |
| "I am too old or unhealthy." | There is no age limit for donors, and suitability is assessed only at the time. |
Living Kidney or Liver Donation: Tests and Records
If you are considering donating to a family member, the medical workup is thorough. It protects both you and the recipient. Typical tests include:
- Blood group and Rh typing (see our blood group guide)
- HLA typing and crossmatch to check immune compatibility
- Kidney function, eGFR and urine tests, including urine microalbumin (ACR)
- Liver function tests, and for liver donors, imaging to measure liver volume
- Viral markers: HIV, Hepatitis B (HBsAg) and Hepatitis C
- Blood sugar, HbA1c, lipid profile and thyroid tests
- ECG, 2D echo and chest X-ray
- CT angiography to map the kidney's blood vessels
- A psychological assessment and an Authorisation Committee review of documents
Living donors generally do very well, but they need lifelong yearly check-ups of blood pressure, kidney function and urine protein. That means years of reports that should be easy to compare.
The donation process also generates a large pile of paperwork: relationship proofs, Form 1 to Form 4 documents, committee approvals and dozens of lab reports from different labs. When you upload your reports to MedicalVault, your creatinine, eGFR and other results are extracted automatically, and MedicalVault's trend analysis lets donor and recipient both see how their kidney function is holding up year after year. The family sharing feature helps when one sibling is coordinating care for a parent who has received a transplant. You can also request complete copies of hospital records at any time; our guide on your right to medical records explains how.
Key Takeaways
- India performed a record 20,138 transplants in 2025, but deceased organ donation in India remains under one donor per million people, far below what is needed.
- One brain-dead donor can save up to eight lives through heart, lungs, liver, kidneys, pancreas and intestine, and help many more through corneas and tissues.
- Brain stem death is legal death under THOTA 1994 and must be certified by a four-doctor board, tested twice at least six hours apart.
- You can pledge online through NOTTO with Aadhaar OTP in a few minutes, or call 1800-11-4770. There is no upper age limit for donors.
- Since 2023, patients can register for a deceased-donor organ in any state, patients above 65 can register, and waitlist registration fees have been dropped.
- Your family's consent is what makes donation happen. Tell them clearly, and encourage them to pledge too.
- Living donors and transplant recipients need lifelong monitoring; keeping every report in one place with MedicalVault makes year-on-year trends easy to follow.