Every week, Imran Ali* travels over 30 kilometres to a dialysis centre, a routine that has kept him alive for nearly three years. Each session costs around ₹3,500, and when combined with medication and travel, his monthly medical expenses soar to ₹70,000–₹80,000. For Imran and his family, it’s a relentless cycle of financial and emotional stress.
“We’ve sold land, borrowed from relatives, and still, I’m waiting for a transplant,” says Imran, who is currently at number 41,000 in a waiting list of over 2 lakh kidney transplant applicants in India. “I was told not to expect a call anytime soon. I don’t even know if I’ll live long enough to move ahead in the list.” Imran’s doctors have warned that he may not survive more than three months without a transplant.
Imran’s story is not unique. It reflects the reality of thousands of people across India suffering from end-stage kidney disease (ESKD), trapped in a system where need drastically outweighs availability. According to data from the National Organ and Tissue Transplant Organization (NOTTO), kidney transplants are among the most sought-after and performed procedures in India. Experts suggest that addressing India’s growing burden of ESKD requires a two-pronged approach: tackling the root cause of rising non-communicable diseases (NCDs) like diabetes and hypertension, and simultaneously addressing the critical shortage of organ donors.
Growing need, limited response
J. Amalorpavanathan ,founder-member secretary, Transplant Authority of Tamil Nadu, observes that while the demand for kidney transplants has grown exponentially, the supply has not kept pace. “Even countries like the United States and Spain, with well-established transplant programmes, are struggling. In India, the gap is much wider,” he says.
As per estimates, between two to three lakh patients require a kidney transplant annually in India. Official data lists over 92,000 patients registered for transplants, but the real number is believed to exceed 2 lakh. Of the 13,600 transplants performed annually, just 1,851 involve deceased donors. The rest are from living donors, mostly close relatives. For those without a matching family donor, the chances become slim, and the waiting period, indefinite.
Limesh M., consultant nephrologist and transplant physician at Narayana Health City, Bangaluru, explains, “The risk of death for kidney transplant recipients is less than half that for those on long-term dialysis. It also dramatically improves quality of life.”
Still, only 2.4% of patients with kidney failure in India undergo a transplant. The number of patients on waiting lists increases by 10% each year, but transplants grow at just 4%, say experts. The average wait time for a deceased donor kidney is between three and five years, and prolonged dialysis, which patients have to undergo while waiting, is not only a financial burdens but also reduces post-transplant survival and quality of life.
Closing the gap: deceased and cardiac death donations
One of the major ways to address this shortfall, according to Dr. Amalorpavanathan, is to improve the recognition and use of organs from brain-dead donors. He also stresses the need to include marginal donors, such as those aged between 60–70 who may have suffered a stroke. “While these kidneys may not be ideal for younger patients, they can be life-saving for older recipients. Matching marginal donors with marginal recipients is a pragmatic step,” he says.
Dr. Amalorpavanathan also emphasises the importance of initiating Donation After Cardiac Death (DCD) programmes in India. “DCD is already practiced widely in countries like the U.K. and U.S.A. With proper systems in place, this could be a respectful and viable way of increasing organ availability,” he says. In DCD, organs are retrieved from patients who experience cardiac arrest in intensive care settings. Though medically complex, this method has been proven to extend donor pools significantly in other nations, he points out.
The promise of kidney swaps
When deceased donor kidneys are not available, living donors — usually family members– offer the next best option. However, India’s legal restrictions on unrelated donors, meant to prevent commercial exploitation, often limit options for patients with incompatible relatives.
Sunil Shroff, consultant urologist and transplant surgeon, cites the successful case of the first swap transplant in India the that led to NOTTO’s decision to have a ‘uniform one nation one swap transplant programme’ .
Dr. Shroff emphasis the potential of swap transplants (paired kidney exchanges). “In March 2025, two incompatible donor-recipient pairs in Chhattisgarh were successfully matched through a swap programme,” he says. “Both donors and recipients recovered well. If supported systematically, swap programmes could increase transplant numbers by 10 to 15 percent.”
This approach is particularly useful for blood group or tissue match incompatibilities, where new drug therapies and plasma exchange can be costly, as Dr. Limish adds, “With policy and institutional support, this model could be scaled nationally.
Need to expand the donor pool
Dr. Limesh stresses the urgent need to expand the donor pool. He suggests that increasing public awareness, encouraging families of brain-dead patients to consider donation, and using grief counselors to sensitively guide them can help bridge this gap. He highlights that transparency, empathy, and trust-building are essential, especially at the moment of loss.
“Ultimately, we need a combination of stronger public health measures to prevent kidney failure, improved policies that enable ethical donation, and sustained community education that fosters trust,” Dr. Limesh says. “
Policy, prevention, and awareness
Solving India’s transplant crisis also demands a multifaceted approach that addresses prevention, policy, and public awareness. A major step forward lies in strengthening public health systems to proactively manage and prevent conditions like diabetes and hypertension, which are leading causes of kidney failure. At the policy level, refining existing laws to encourage ethical and informed organ donations while safeguarding individuals from exploitation is crucial. Equally important is transforming public perception through sustained awareness campaigns that challenge cultural taboos and promote the importance of organ pledging.
As Dr. Limish emphasises, “Innovative approaches and continued public education are key to increasing the number of living and deceased donors. Only then can we offer a second chance to the growing number of Indians silently suffering from kidney failure.”
(*Name changed to protect privacy)
Published – April 26, 2025 05:25 pm IST