Kidney transplant crisis in India: Why cadaver donations remain alarmingly low

Every year, thousands of Indians suffering from kidney failure cling to the hope of a transplant, but for many, that hope fades with time. With long waiting lists, a severe shortage of cadaver organ donors, and financial barriers, many patients die before ever receiving a transplant.

Approximately 14,000 kidney transplants are done annually in India, yet fewer than 2,000 of these come from deceased donors. This means the vast majority rely on living donors—family members or close relatives who match their blood type and are willing to donate a kidney. The numbers paint a stark picture of the crisis.

At Aakash Healthcare in Delhi, for instance, over 200 transplants have been conducted since 2001, but only four involved cadaver donations. Meanwhile, the hospital currently provides dialysis to over 200 patients, yet fewer than 2% ever get the chance for a transplant.

“Regarding the frequency of living versus deceased kidney donations, it has been observed that deceased kidney donation remains uncommon in North India, accounting for approximately 1% or less of the total transplants performed. Kidney transplants continue to be predominantly sourced from living-related donors,” said Dr Reetesh Sharma, Director & Head, Nephrology & Kidney Transplant Medicine, Asian Hospital.

Also read: India’s growing kidney health crisis: Why it’s going unnoticed

Barriers to organ donation

Despite India’s vast population and increasing medical advancements, deceased kidney donations remain rare. Experts attribute this to a lack of awareness, sociocultural stigmas, and inadequate medical infrastructure.

Dr Swati Mane, Consultant, Nephrology, Jupiter Hospital, said that a major barrier to organ donation is the lack of public awareness, particularly regarding brain death. She clarified that organ donation in such cases does not involve retrieving kidneys from individuals who have died naturally but from brain-dead donors—often victims of traumatic brain injuries from road accidents or strokes. These individuals remain in an irreversible coma, fully dependent on machines, with no chance of brain recovery, though their organs remain functional.

Dr Mane further added that due to limited awareness, many families decline organ donation, especially when dealing with the sudden loss of a loved one. In such situations, grief counsellors play a crucial role in guiding families through the decision-making process.

Sociocultural beliefs further complicate the issue. “Among some prospective recipients, there is denial in accepting organs from deceased individuals due to fear or mistrust,” said Dr Soubeer Ghosh, Consultant, Nephrology and Kidney Transplant Medicine, PSRI Hospital. “Sociocultural factors prevent many people from signing up to become donors after death. Besides, lack of medical infrastructure and personnel are pan-India issues in this area, which require urgent attention,” he added.

At Aakash Healthcare alone, over 45 patients are currently on the waiting list for a cadaver kidney.

Dr Vikram Kalra, Additional Director, Nephrology & Kidney Transplantation, Aakash Healthcare, said other countries have taken different approaches to solving the crisis.

“In Spain, organ donation rates are higher due to the mandatory opt-out system, which ensures a greater availability of cadaver kidneys. India follows an opt-in system, which significantly affects the number of cadaver transplants performed,” he explained.

Financial burden of transplants

Even when a transplant is possible, financial constraints often prevent patients from going through with it. Many continue dialysis simply because they cannot afford the one-time cost of surgery.

At Aakash Healthcare, the cost of a kidney transplant from a living donor is approximately Rs 8 lakh, covering surgery, post-operative care, and immunosuppressive medications. For the first three months post-transplant, immunosuppressive drugs cost around Rs 15,000 per month, eventually decreasing to Rs 4,000–6,000 per month after six months.

“The overall cost of a kidney transplant depends on the type of transplant. If the blood group is compatible, the cost is around Rs 6–8 lakh. If not, it is higher—around Rs 10-15 lakh—depending on various factors,” Dr Ghosh said.

“Financial constraints do influence the decision to continue dialysis,” said Dr Reetesh.

“Though transplantation is a one-time expenditure, unlike dialysis, which requires continuous financial investment, many patients struggle to arrange the necessary funds in a single instance and, as a result, opt for dialysis. However, if financial support can be secured, transplantation remains the more effective and medically beneficial option,” he added.

Reality of life on dialysis

For those who remain on dialysis, life becomes a cycle of hospital visits. Patients typically undergo two to three dialysis sessions per week, each lasting four hours. Beyond the inconvenience, dialysis significantly reduces life expectancy and brings a host of complications.

“Long-term dialysis is associated with several complications, including infections, vascular access issues, cardiovascular disease, and malnutrition. Over time, patients may also develop bone weakness and muscle disorders,” said Dr Kalra.

Life expectancy on dialysis remains significantly lower than that of transplant recipients.

“Data suggests that the 10-year survival rate for dialysis patients is approximately 15–20%, meaning over 80% do not survive beyond ten years. In contrast, kidney transplantation offers a near-normal quality of life,” added Dr Reetesh.

“In patients on long-term dialysis, heart disease and recurrent infections are the most frequently encountered complications, followed by nutritional deficiencies, muscle wasting, and bone disorders like osteoporosis,” said Dr Ghosh.

Also read: Delhi: 80-year-old woman donates kidney to save her son’s life

The way ahead

Experts agree that India needs stronger awareness campaigns to educate the public on organ donation. Schools could play a major role in teaching children about organ donation, allowing them to pass this knowledge on to their families.

“Success stories need to be promoted so that the population across all educational backgrounds becomes aware,” said Dr Ghosh.