What makes the system unique is how it has institutionalised trust and integrity. From hospital licensing to protocol-driven brain death certification, every layer of the system builds trust for families agreeing to donate the organs of a loved one — in the deepest moment of their personal loss — to give a gift of life to a stranger.

The inclusion of brain death within the law provides the legal basis for deceased organ donation. Strict protocols for brain death declaration by a panel of four doctors, including a neurologist or neurosurgeon — hospitals need to be registered — with only trained transplant coordinators to counsel grieving families, facilitate the donation process.

The living organ donation process undergoes a mandatory review by ethical committees known as Transplant Authorisation Committees. These interview donors and recipients, which helps prevent exploitation and organ trafficking.

The organisational architecture to implement this legislation is equally impressive. The National Organ Transplant Programme (NOTP) operating through NOTTO has the mandate to improve awareness about a healthy lifestyle and the prevention of organ failure, raise awareness about organ and tissue donation from deceased persons, augment infrastructure for transplantation, and provide training for manpower and research. NOTTO operates via five Regional Organ and Tissue Transplant Organisations (ROTTOs) and 21 State Organ and Tissue Transplant Organisations (SOTTOs), coordinating 966 hospitals/institutions, including 702 organ transplant cent, 142 organ retrieval centers, and the remaining as tissue centres across India. This hierarchical network supports equitable donor allocation, standardised operating procedures and donor registries at state and national levels, helping reduce waste and ensure fair matching for patients in need.

Equally important has been the role of coordination and public-private partnership. India’s policy empowers NGOs, civil society, and private hospitals to work with government authorities. Non-governmental organisations such as the MOHAN foundation have built and managed transplant coordinator training programmes in partnership with medical authorities. Well-trained coordinators considerably boost consent rates for deceased donation, and these professionals, working out of hospitals nationwide, help to identify potential donors, educate families, and manage logistics. Public-private partnerships also help in creating protocols for donor identification, consent, transportation and allocation.

A replicable system

The results are evident. Annual organ donation has climbed from fewer than 5,000 in 2013 to over 15,000 by 2022. Perhaps the most striking example of India’s policy gains is seen in Tamil Nadu. By making brain death certification mandatory in 2008 and establishing a state transplant authority, TRANSTAN, in 2015, and operating a state registry for fair allocation, Tamil Nadu raised its deceased donation rate to 1.8 per million, which is above the national average of 0.65 per million. Andhra Pradesh’s Jeevandan programme has deployed mobile transplant coordinator teams between hospitals, introduced financial and funeral support to donor families, and elevated state‑honour recognition. This helped the state to cross 200 deceased organ donations in 2024.

While India’s journey has not been without its challenges, with consent rates varying across regions, the policy mechanisms in place to address them are what make India’s system replicable. Our vision must go beyond geography. India now has the opportunity, and indeed the responsibility, to share its policy framework with other developing nations.

Other developing countries can take a leaf out of India’s transplant policies. Establishing a central legislative act that defines brain death and banning organ commerce is the first step. Creating accountability structures, such as mandatory transplant authorisation committees and hospital licensing for transplantation, ensures legal and ethical compliance. Offering emotional support and recognition to donor families reinforces public trust and encourages future donations.

States could begin with pilot programmes in a few key hospitals, identify effective coordinators, and gradually scale. The legislative and administrative architecture is already proven and ready for adaptation. India’s example shows how a carefully crafted policy framework can reshape outcomes. If other developing nations adopt and adapt these institutional lessons, they too can extend the gift of life to thousands more.

The writer is founder-chairman, Apollo Hospitals Group