Gender disparity in organ transplantation is a global problem affecting each step of the transplantation process, from organ donation, recipient listing, waiting times and access, to post-transplant outcomes. This inequality is most visibly expressed in the overrepresentation of women as living donors, while men continue to be the majority of transplant recipients.
India’s case is a particularly striking example of this gender imbalance. Women constitute the majority of living organ donors, but men get the majority of transplants. This is not a new divide.
As per recent data from the National Organ and Tissue Transplant Organization (NOTTO), between 2019 and 2023, 63.8% of living organ donors were women and 69.8% of transplant recipients were men. In 2019 and 2020, roughly two-thirds of living donors were women, but only about a quarter of recipients were women. A 2025 analysis found that women accounted for 36,038 of the 56,509 living donations over the five-year period studied, also highlighting the scale of the imbalance. Of these, however, only 17,041 were transplanted into women, as against 39,447 transplanted into men.
Women’s decisions to donate organs are shaped by a complicated interaction between sociocultural expectations, economic conditions and family structures. In many Indian homes, women, particularly wives and mothers, are still expected to put the needs of their families before their own. The expectation can be particularly sharp in the case of a life-saving transplant for a close family member. Studies have noted the role of women in familial organ donation. These figures are suggestive of a long-standing social tendency to assign the bulk of care work to women, and perhaps even to the final act of bodily sacrifice. Psychological and experiential reasons may also play a role in women’s higher willingness to donate. Past experiences with the health care system, such as pregnancy and delivery, may increase familiarity with medical settings and trust in health care providers. But these explanations have to be discussed in the light of the strong influence of social conditioning. What seems like a personal choice can sometimes be influenced by expectations, emotional duties or an unspoken belief that a woman should make sacrifices for her family. Patriarchal attitudes can also be a disincentive for men to become donors. Men are generally considered the primary breadwinner and economic provider for their families. Thus, the prospect of a man needing major surgery, a long recovery period or a temporary loss of income might be seen as an unacceptable financial risk. Such pressure can transfer the burden of donation to women. This dynamic is particularly problematic when financial dependency is a factor. The costs of evaluation, surgery, recovery and the potential loss of household income may make male donation seem less feasible. Thus, the line between voluntary altruism and coercion can become perilously blurred. This has implications for more than just transplant statistics. Essentially, it’s a question of equity, autonomy and justice in healthcare. An organ donation system cannot be truly equitable when it is based on social and familial pressures about who is supposed to donate, and on socioeconomic or structural barriers about who gets the transplant. Interventions are required at several levels to address this gap. Awareness must be the starting point, but awareness is not enough. Transplant services and community-based initiatives should be extended to rural, underserved and marginalised regions and not be confined to major urban centres. In particular, women should have equal access to information, evaluation and transplantation services. Equally important is strengthening psychosocial assessment of potential living donors. Pre-transplant evaluation should not only include medical suitability and financial considerations, but also explore the wider social environment in which the donation decision is being made. Healthcare professionals should be trained to recognise warning signs of coercion, domestic abuse, threats, violence, manipulation and financial dependence. Donors must be provided with real opportunities to make informed and voluntary decisions, including the opportunity to withdraw without fear of repercussions. Better and more comprehensive data collection is also needed in India. Good, disaggregated data on donors and recipients – disaggregated by gender, age, socioeconomic status, geography, relationship to recipient and other relevant factors, would enable policymakers to better identify disparities and design evidence-based interventions. The challenge is to move beyond the financial transaction of organ donation, and to acknowledge the quieter pressures that can exist within families. Sometimes coercion doesn’t take the form of an explicit threat. It could be the expectations of a wife, the responsibilities of a mother or the assumption that a woman should sacrifice herself for the family’s survival. The bigger message is hard to miss: gender inequality does not stop at the hospital door. It can influence who gives, who gets, who waits and ultimately who gets a chance to live. (Dr Shivakumar S. Patil is consultant, renal transplant surgery, Manipal Hospital, Hebbal. [email protected])
Because they are seen as more expendable in the family’s economic structure, in such cases, women may be subtly, and in more troubling cases, explicitly encouraged to donate,. It is, therefore, the duty of healthcare providers to fully discuss these issues at every stage of the process, explain the ramifications of a donation and t ensure that they are indeed personal choices of women, and not influenced by other factors. Because national averages can hide significant inequalities at the regional and community level, grassroots research is important.
Mothers are, on average, 73% of all parental donations, and wives are 91% of donations between married couples.
This gendered pattern raises a fundamental question: why are women expected to give and men positioned to receive in disproportionate numbers? The answer goes far beyond biology.
