Mumbai: India may perform the world’s third-highest number of organ transplants, but it meets only a fraction of the country’s actual need, according to the first study assessing the unmet need of transplants.Published in The Lancet Regional Health–Southeast Asia, the study estimates that India required nearly 3.9 lakh kidney, liver, heart and lung transplants in 2021, a figure likely to rise to 4.63 lakh annually by 2040 as the population ages and chronic diseases become more common. Yet, at present, only a small proportion of patients receive a transplant.The authors said just 7.2% of the total kidney transplants needed in 2021 were conducted; similarly, transplants of liver (1.5% of the total needed), lungs (1.2%) and heart (0.2%) were performed across the country.“India performs the third-highest number of transplants, but a raw number tells you nothing unless you know the size of the queue behind it,” said the study’s author Dr Manish R Balwani, secretary of the Indian Society of Organ Transplantation (ISOT).“In the US and Europe, waiting-list registries tell you exactly how many people are waiting for a transplant. We wanted to convert what doctors see every day into numbers that policymakers can act upon,” Dr Balwani said.Using Global Burden of Disease estimates, transplant registry data and demographic projections, the researchers estimated that in 2021 about 1.26 lakh patients in India required kidney transplants, 1.85 lakh liver transplants, 83,841 heart transplants and 11,253 lung transplants. Demand is projected to increase to 1.44 lakh kidney, 2.11 lakh liver, 95,711 heart and 12,846 lung transplants annually by 2040.Dr Vatsala Trivedi, who performed the country’s first cadaveric kidney transplant in 1997 after India passed the Transplantation of Human Organs Act, said, “There is indeed a wide gap between demand and supply of organs across India.”Dr Trivedi, who wasn’t involved in the study, added that there is an urgent need to “intensify solid organ transplant services” with correct healthcare policies based on “facts and not on perceptions.”The new study has thrown up some unexpected findings: India has a higher estimated need for liver transplantation than kidney transplantation. This is unlike most Western countries and reflects India’s growing burden of chronic liver disease.The study also points to stark geographical inequities. Maharashtra, Tamil Nadu, Delhi-NCR, Kerala and Telangana together account for 80-96% of India’s transplant activity, despite housing only about 29% of the country’s population.“The geographic concentration was the most striking finding,” said Dr Vivek B Kute, treasurer of ISOT and a co-author. “Whether you live or die of organ failure in India depends heavily on your pincode.”The study also found that India’s transplant programme continues to rely on living donors, with about 82% of transplants involving a living family donor. Another concern is gender disparity: Women receive far fewer transplants than men, while they make up the majority of living organ donors. “Women make up nearly half the disease burden but received only 36.8% of kidney, 30.4% of liver and 23.5% of heart transplants,” said Dr Kute.
