Justice and equality: On organ transplantation, gender skew 

When decisions are based on the principle of natural justice, they serve a particular social purpose or aim to right a specific wrong. The National Organ and Tissue Transplant Organization’s (NOTTO) recent advisory, stating that women patients and relatives of deceased donors awaiting transplants will get priority as beneficiaries, walks the path of rewriting a gender trope. There is a gender skew as NOTTO’s decadal data (2013-23) indicates. As per NOTTO, in 2023, women constituted 63% of all living donor transplants, and yet they comprised between 24% (for heart) and 47% (lung) as beneficiaries of organs for transplantation. In kidney transplants, women were only 37% of the beneficiaries in 2023, while for liver, women’s share was 30%. For pancreas transplant, women totalled up to 26% of total beneficiaries. Analysis in the British Medical Journal showed that in the past five years, women contributed to 36,038 of the 56,509 living organ donations in India, and benefited from transplantation in only 17,041 cases. NOTTO, in its advisory, said the recommendation was an attempt to address the gender imbalance among organ transplant recipients; to make provisions for additional points in the allocation criteria for women patients in the waiting.

While certainly laudable in what it sets out to do, this move could well be beset with procedural hassles. Currently, organ allotment protocols do not allow for prioritising any one recipient over another, except on grounds of health. There are, therefore, no provisions to prioritise women and/or near relatives of previous donors. Since the NOTTO advisory, questions have also been raised about whom the definition of ‘near relatives’ should include, and if all families involved in donating cadaveric organs for transplantation (since 1995) would be considered beneficiaries. The primary fear among implementers seems to be that this might become another backdoor way to facilitate out-of-turn allotments, particularly as organ harvesting rackets continue to be busted in India. However, it makes little sense to throw the baby out with the bathwater, particularly when operating with the intent to be more inclusive, in a society shaped by patriarchal norms. It is crucial that NOTTO makes this a participative process, taking along various agencies involved in implementation. While it is important to ensure proper implementation under the Transplantation of Human Organs Act, and widen access to the limited pool of organs, above all, it is imperative that the principle of not denying anyone whose need for an organ is the greatest, based on health parameters, is always adhered to.