Why we need to focus on the gender disparity in organ transplantation

The gender disparity in organ transplantation is a global issue that permeates every aspect of the donation, listing, waiting times, access, and post-transplant outcomes. In India, this imbalance is particularly pronounced, with women accounting for the majority of living organ donors but men receiving the majority of transplants. According to data from the National Organ and Tissue Transplant Organization (NOTTO), between 2019 and 2023, 63.8% of living donors were women, while 69.8% of transplant recipients were men.

This imbalance has been consistent over time. In 2019 and 2020, approximately two-thirds of living donors were women, but only about a quarter of recipients were women. A 2025 analysis revealed that women constituted 36,038 of the 56,509 living donations over the five-year period, yet only 17,041 of these donations resulted in transplants for women, compared to 39,447 transplants for men.

The question arises: why is there such a gendered pattern in organ transplantation? The answer extends beyond biology and delves into sociocultural expectations, economic conditions, and family structures. In many Indian households, women, especially wives and mothers, are expected to prioritize family needs over their own. In cases of life-saving transplants for close family members, this expectation can be particularly acute.

Studies indicate that women play a significant role in familial organ donation, with mothers making up 73% of all parental donations and wives comprising 91% of donations between married couples. These statistics suggest a deeply ingrained societal tendency to assign the majority of caregiving responsibilities and, by extension, the ultimate sacrifice to women.

Psychological and experiential factors may also contribute to women's higher willingness to donate. Past experiences with the healthcare system, such as pregnancy and childbirth, might increase familiarity and trust in medical settings. However, these factors must be considered alongside the powerful influence of social conditioning. Personal choices can be influenced by expectations, emotional duties, or the unspoken belief that women should make sacrifices for their families.

Patriarchal attitudes can deter men from becoming donors, as the prospect of a man requiring major surgery, a lengthy recovery, or a temporary loss of income may pose an unacceptable financial risk. This pressure can inadvertently shift the responsibility of donation to women, who are often perceived as more expendable within the family's economic structure.

The line between voluntary altruism and coercion can become blurred, raising concerns about the voluntariness of women's donation decisions. Healthcare providers must thoroughly discuss these issues at every stage of the donation process, ensuring that women's decisions are genuinely voluntary and not influenced by external factors. This has broader implications for equity, autonomy, and justice in healthcare.

To address this gap, several interventions are necessary. Awareness campaigns are essential, but they must be accompanied by extended transplant services to rural, underserved, and marginalized regions. Women must have equal access to information, evaluation, and transplantation services. Strengthening psychosocial assessments of potential living donors is also crucial, with evaluations encompassing medical suitability, financial considerations, and the broader social environment influencing donation decisions.

Healthcare professionals should be trained to identify signs of coercion, domestic abuse, threats, violence, manipulation, and financial dependence. Donors should be given the opportunity to make informed and voluntary decisions, including the ability to withdraw without repercussions. Enhanced and comprehensive data collection is vital, with disaggregated data on donors and recipients by gender, age, socioeconomic status, geography, relationship to the recipient, and other relevant factors enabling policymakers to identify disparities and design targeted interventions.

Grassroots research is essential to uncover regional and community-specific inequalities that national averages may mask. Ultimately, the challenge lies in moving beyond the financial aspects of organ donation and acknowledging the subtle pressures that can exist within families. The broader message is clear: gender inequality extends beyond the hospital doors and can influence who donates and who receives transplants.