States Must Act to Eliminate Gender Disparities and Ensure Transparency in Organ Transplants: Supreme Court Issues Comprehensive Directions

Organ Donation Cannot Remain a Privilege of a Few, It Must Become a Right of All: Supreme Court of India issued sweeping directions requiring the Union of India to convene a nationwide meeting of all States and Union Territories to gather crucial information regarding the state of organ transplantation governance across the country.

The Bench comprising Justice B.R. Gavai and Justice Augustine George Masih emphasized that disparities in organ transplantation — especially along gender lines — and the lack of uniform adoption of the Transplantation of Human Organs and Tissues Act, 1994 and its 2011 amendments pose serious concerns impacting citizens' health rights.

The Court sternly reminded that: "Organ transplantation must not remain an opportunity reserved for the privileged or male recipients. Systemic discrimination and policy gaps must be addressed with immediate urgency."

The writ petition was filed by the Indian Society of Organ Transplantation, highlighting the uneven implementation of national organ transplant guidelines, gender disparities in organ donations and recipients, lack of uniform policies across States, and inadequate infrastructure for multi-organ transplantation in public hospitals.

The Court, recognizing the gravity of the matter, sought comprehensive data from all State Governments and Union Territories on various aspects relating to organ transplantation systems, legal compliance, gender equity, transparency, and awareness initiatives.

The Supreme Court listed a wide range of focused queries to be addressed by the Union and State Governments. Justice Gavai, speaking for the Bench, directed that:

"Soliciting detailed information is not a mere bureaucratic exercise; it is essential to understand and remedy the structural gaps that are undermining organ transplant accessibility and fairness."

The Court’s inquiry included, among other critical aspects:

Whether States have adopted the Transplantation of Human Organs and Tissues Act, 1994, its 2011 Amendment, and 2014 Rules, and if not, the reasons behind such non-adoption.

Whether States have implemented National Organ and Tissue Transplant Organization (NOTTO) guidelines to facilitate organ transplants uniformly.

Statistical data showing cadaveric transplants versus live donations, highlighting the extent of reliance on living donors instead of promoting cadaver donations.

The extent of gender disparity — noting that female live donors outnumber males, but male recipients exceed female recipients — and the steps being taken by States to correct this imbalance.

Whether relatives of brain-dead patients are adequately informed about the possibility of organ donation to boost cadaveric transplants.

The existence and alignment of 'swap transplantation' policies with the 1994 Act.

Organ allocation procedures being followed by States and whether they align with the points system framed by NOTTO.

The number of hospitals, public and private, equipped for multi-organ transplants and the additional infrastructure needed to meet national requirements.

The degree of public awareness initiatives and whether financial assistance is provided to donors and recipients.

Whether there is a national-level portal regularly updated with data on donors and recipients to ensure transparency and efficiency in organ matching.

The Court expressed particular concern over the systemic gender inequity, observing: "The alarming difference in the number of female donors compared to female recipients reflects an underlying social bias that the States must address as a matter of priority."

In a robust call for nationwide reform, the Supreme Court directed the Union of India to convene the meeting of all Chief Secretaries and Public Health Secretaries at the earliest and to submit a detailed report by July 18, 2025.

The matter is now listed for further hearing on July 21, 2025, where compliance and future action plans will be scrutinized.

The Court’s concluding sentiment resonates powerfully: "Access to organ transplantation must be equitable, transparent, and free from discrimination — it is an extension of the fundamental right to life under Article 21 of the Constitution."

By prioritizing structural reform in the field of organ transplantation, the Court has taken a significant step toward ensuring that health rights in India are not left to chance, privilege, or systemic discrimination.

Date of Decision: April 21, 2025