Organ Transplant Process: From Application to Surgery and Long-Term Monitoring

For a patient facing end-stage organ failure, information about the need for transplantation is only the beginning of a complex journey. This journey includes medical evaluation, registration, documentation processing, waiting list management, donor matching, organ allocation, and then the surgery itself and subsequent long-term monitoring.

In India, this entire process is coordinated through a network that includes the National Organ and Tissue Transplant Organisation (NOTTO), regional and state structures, registered transplant hospitals, and transplant coordinators.

The scale of this system has significantly increased. According to a Press Information Bureau release from February 2026, nearly 20,000 organ transplants were performed in India in 2025, substantially exceeding the figure of less than 5,000 in 2013. Furthermore, over 1,200 families donated organs of their loved ones after death in 2025.

However, these figures reflect only part of the picture. Behind every transplant is a sequence of events that begins long before the surgeon enters the operating room, and often long before the organ is offered to the recipient. NOTTO indicates that patients undergo evaluation by a multidisciplinary team, are registered through the transplant center, vetted by the relevant allocation body, and, once approved, placed on the appropriate waiting list.

The Process Begins at the Transplant Center

A patient with progressive organ failure is first referred to a licensed transplant center. Doctors assess the underlying disease, the degree of organ damage, and determine if transplantation is medically justified. It is important to note that not every patient with end-stage organ failure is suitable for transplantation.

Dr. Manoj Gupta, Senior Director and Head of Liver Transplantation at Yatharth Super Speciality Hospital, explained that the initial assessment involves reviewing the patient's medical history, physical examination, blood and tissue tests, imaging, organ function assessment, infection screening, and checking for any comorbidities. Suitability is determined by several factors, including the patient's overall health status, the degree of organ failure, surgical fitness, the likelihood of benefit from transplantation, and the ability to adhere to post-operative treatment regimens.

Nevertheless, suitability also depends on other aspects. Dr. Gautam Kumar, Consultant for Liver and Hepatic Transplantation Services at SPARSH Hospital, added that criteria include the absence of absolute contraindications, such as active systemic infections, untreated malignancies, severe substance abuse, or irreversible comorbidities.

After this, the hospital and the transplant coordinator gather all necessary information for registration. Once the application is accepted, the patient's data enters the relevant transplant registry and waiting list. The waiting period can range from one day to several years.

What Does Being on the Waiting List Mean?

Being on a transplant waiting list is not merely waiting in line. NOTTO reports that patients are ranked according to medical criteria, divided into regular and urgent categories, with priority depending on the specific organ. For example, for kidney transplantation, one of the factors considered is the time spent on regular dialysis; other organs use different criteria.

Dr. Kumar clarifies the practical application of these organ-specific criteria: 'Liver allocation often uses the MELD score (Model for End-Stage Liver Disease), whereas for heart allocation, priority is given to patients on mechanical support. Pediatric patients and acute cases with a high degree of urgency often receive priority.' NOTTO guidelines also provide for urgent or 'Priority One' categories for patients meeting organ-specific requirements. Such cases may be reviewed by an expert committee before priority is granted, and hospitals are required to provide regular clinical reports.

Registration does not freeze the patient's status. Their health condition continues to be monitored, and records are updated. Depending on their health status, the patient may remain active, become inactive, or be deemed medically unfit for transplantation.

When Becomes a Donor Organ Available?

The next stage in the process occurs when an organ becomes available. It can come from a living donor, typically a kidney or part of a liver, or from a deceased donor after confirmed brain death. At this point, as reported by Organ India, 'the hospital transplant coordinator consults the family and offers them the opportunity to donate organs and tissues.'

Consent from relatives is required before removal. Thus, the promise of donation is made only at the beginning of the conversation. Organ India emphasizes: 'In India, it is much more important to talk to your family about your decision than to make a promise to donate organs and receive a donor card.'

Once the donor organ is identified, a fast, highly coordinated race against time begins. Blood type compatibility and cross-matching between the donor and potential recipient are checked, and the organ itself is assessed for viability. Dr. Kumar explains: 'The surgical retrieval team collects the organ, and a preservation solution is administered. Logistics transport schemes are activated—often using special 'green corridors' or air transport—for immediate organ transfer.'

The recipient is called to the hospital, re-evaluated, and prepared for surgery, while the surgical team stands ready to proceed as soon as the donor organ arrives.

From Brain Death to Retrieval

The deceased donor is maintained in a medical state while permissions and retrieval arrangements are finalized, which helps preserve viable organs until the moment of extraction. However, the clock starts ticking after retrieval: each organ has a limited preservation window. The preservation time is 4–6 hours for the heart and lungs, 6–10 hours for the intestines, 12–15 hours for the liver, 12–24 hours for the pancreas, and 24–48 hours for the kidneys.

Cost remains another significant barrier to transplantation in India. Dr. Kumar noted that 'initial surgical costs range from 10 lakh to 35 lakh rupees depending on the organ (kidney versus liver/heart) and the hospital sector (public or private).' But the financial burden does not end after the operation. Lifelong use of immunosuppressants, rejection treatment, and 'regular diagnostic monitoring add 15,000–30,000 rupees monthly.'

This narrow time window makes allocation an extremely coordinated process. Organs are evaluated, potential recipients are identified, and transportation is organized.

Growth in Transplants in India

The national system has expanded significantly over the last decade. The Ministry reported that in 2025, over 1,200 families offered to donate the organs of their loved ones after death. According to a PIB release, 'more than 4.8 lakh citizens have registered for post-mortem organ and tissue donation through the Aadhaar-based verification system since September 17, 2023.' The release also mentioned that India has gained experience in complex heart, lung, and pancreas transplants and stated that the country 'leads the world in hand transplants and performs more hand transplants than any other country.'

The government noted that this growth reflects improvements in post-mortem donation, transplant coordination, and national organ exchange.

Gap Between Supply and Demand Persists

Even after the operation, the process continues. Recipients require lifelong monitoring and immunosuppressive drugs, which can also carry long-term risks. Dr. Jagriti Yadav, Medical Director of Laboratory Operations at Cryoviva Life Sciences, stated: 'Major long-term risks include acute or chronic graft rejection, opportunistic infections, cardiovascular complications, nephrotoxicity, and metabolic side effects associated with immunosuppressive medications.'

The increase in transplants has not eliminated the organ shortage. An article published in PubMed Central of the National Library of Medicine in 2024 noted that India performed about 17,000–18,000 solid organ transplants per year, making it the third-largest transplanting country in the world after the USA and China, although transplantation rates per million population remained lower than in several high-income countries.

Data from Organ India and informational materials also highlight the mismatch between the number of patients needing organs and the number of available donors after death. The organization calculated that India has a large reserve of potential brain-dead donors, but a significantly smaller number of actual donors after death.

For a patient on the waiting list, this gap translates into uncertainty: medical fitness and registration do not guarantee the timely availability of a suitable organ. Delhi remains one of the country's major transplant centers. The Delhi government organ donation portal provides information on registered hospitals and transplant services and operates under the aegis of the Department of Health and Social Welfare and the State's Concerned Authority. Information published by the department lists registered institutions for kidney, liver, heart, lung, and pancreas transplants, as well as eye and cornea services.

Foreign Recipients Also Participate in the System

India's transplant system also assists foreign nationals, provided additional safeguards are met. Government guidelines stipulate that an Indian living donor can donate organs to a foreign recipient only if they are close relatives; donors must be at least 18 years old, and visa and registration requirements apply to both parties.

Data shows that in 2023, 18,378 transplants and 18,336 individual recipients were registered in India, including 1,851 foreigners, according to NOTTO data presented in 2024. Delhi recorded the highest number of cases involving foreign recipients—1,445, followed by Rajasthan with 116 and West Bengal with 88. Only nine cases involved organs from non-related deceased donors.

For the recipient, the least noticeable part of the process may be the period between registration and organ offer. During this time, the patient's condition can change. Tests may need to be repeated, treatment adjusted, and the transplant center will update the patient's status in the registry. Consequently, the patient remains under the observation of the transplant team while the allocation system searches for a medically suitable organ. NOTTO asserts that special requests do not guarantee immediate organ receipt or the cancellation of established selection and allocation rules.

India's transplant system is becoming increasingly digital as national coordination and data exchange expand alongside the increase in transplants. Donor registrations verified through Aadhaar exceed 4.8 lakh, and nearly 20,000 transplants were registered in 2025. The next challenge is ensuring effective identification of potential donors, counseling families, retrieval, transportation, and organ distribution. For recipients, this means maintaining medical condition, updating information at the transplant center, and following clinical guidelines.