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

Gender disparity in organ transplantation is a pervasive issue that impacts every aspect of the process, from organ donation to post-transplant outcomes. In India, this imbalance is particularly pronounced, with women being the majority of living donors while men constitute the majority of transplant recipients. According to data from the National Organ and Tissue Transplant Organization (NOTTO), between 2019 and 2023, 63.8% of living organ donors were women, while 69.8% of transplant recipients were men.

This pattern was present even earlier, with women accounting for two-thirds of living donors and only a quarter of recipients between 2019 and 2020. A 2025 analysis revealed that out of the 56,509 living donations over a five-year period, women donated 36,038 organs, but only 17,041 of these were transplanted into women, compared to 39,447 transplants into men.

The reasons behind this gendered pattern extend beyond biological considerations. Sociocultural expectations play a significant role, with women often expected to prioritize their family's needs before their own. In many Indian households, women, particularly wives and mothers, are expected to provide care, even in the face of life-saving transplant needs for close family members.

This cultural expectation can be particularly pronounced in cases where a transplant is required for a family member. Studies have shown that mothers are 73% of all parental donations, while wives are 91% of donations in married couples. These figures highlight the deep-seated societal tendency to assign the bulk of care work to women, often leading to the perception that women should make sacrifices for their families.

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, can increase familiarity with medical settings and trust in healthcare providers. However, these explanations must be considered within the context of strong social conditioning.

What may appear to be a personal choice could be influenced by expectations, emotional duties, or the belief that a woman should make sacrifices for her family. Patriarchal attitudes can also discourage men from becoming donors, as men are typically seen as the primary financial providers for their families. The prospect of a man undergoing major surgery, experiencing a long recovery period, or temporarily losing income might be perceived as an unacceptable financial risk, leading to the expectation that women bear the burden of donation.

This dynamic can be especially problematic when financial dependency is a factor, as women may be subtly or explicitly encouraged to donate due to their perceived expendability within the family's economic structure.

The distinction between voluntary altruism and coercion can become blurred, raising ethical questions about the fairness of the system. Healthcare providers have a responsibility to thoroughly discuss these issues at every stage of the donation process, ensuring that a woman's decision to donate is indeed a personal choice and not influenced by other factors.

This consideration extends beyond transplant statistics, touching on broader issues of equity, autonomy, and justice in healthcare. An organ donation system must be equitable, not merely transactional, and should not be based on social and familial pressures or socioeconomic barriers. To address this gap, interventions are needed at multiple levels.

Awareness campaigns are essential, but they must be accompanied by efforts to extend transplant services to rural, underserved, and marginalized regions. Women should have equal access to information, evaluation, and transplantation services, and healthcare professionals should be trained to recognize signs of coercion, abuse, or financial dependence.

Donors must be empowered to make informed, voluntary decisions, including the right to withdraw without fear of repercussions. Comprehensive data collection is also crucial. Disaggregated data on donors and recipients, including factors such as gender, age, socioeconomic status, geography, and relationship to the recipient, can help policymakers identify disparities and design targeted interventions.

Grassroots research is vital, as national averages can mask significant regional and community-level inequalities. Ultimately, addressing gender inequality in organ transplantation requires moving beyond the financial transaction and acknowledging the underlying societal pressures that can influence both donation and transplantation decisions.

The message is clear: gender inequality permeates beyond the hospital walls, affecting who chooses to donate and who receives the transplant.