A National Organ and Tissue Transplant Organization (NOTTO) study, between 2019 and 2023, 63.8 per cent of living organ donors in India were women, while nearly 70 per cent of recipients were men. More than 36,000 women donated organs, but fewer than 18,000 received transplants. Men, in contrast, received nearly 40,000 organs.
On paper, this is a dataset. In reality, it is a stark reflection of who gives, and who gets to live.
At its simplest, the story is this: in India, women are conditioned to be givers at every stage of life. That expectation does not end at emotional labour or caregiving. It extends, quite literally, to their bodies.
India’s transplant ecosystem relies heavily on living donors, which means these decisions are rarely abstract or institutional. They are made at home—across dining tables, in quiet conversations, within families. And in those moments, medicine recedes while social conditioning takes over.
“The majority of living donors are women. They are wives, mothers, daughters,” says Dr Sunil Shroff, a pioneer in organ donation awareness.
Why is it so? When a serious illness strikes, families do not begin with neutrality. They begin with an unspoken hierarchy of roles. Who will step forward? More tellingly, who is expected to? A wife donating a kidney to her husband is seen as natural. A mother to her child is unquestioned. A daughter to her parents is expected. The language used to describe these decisions reinforces the illusion of choice: she wanted to help, she chose to give, anyone would have done the same.
But these choices are shaped within a framework of expectation. The reverse—men donating to women—exists, but without the same inevitability. It is less assumed, less socially encoded. And when families face financial or emotional strain, priorities emerge. Men, still widely viewed as primary earners, are often treated as more “urgent” to save.
As nephrologist Dr Vivekanand Jha notes, access to transplantation in India is deeply influenced by “socioeconomic and gender factors”. In practice, that means a man’s illness can trigger immediate mobilisation, while a woman’s illness may be met with hesitation, delay, or compromise.
This is where the imbalance becomes impossible to ignore. The system draws disproportionately from women as donors, yet invests less in their survival. Women are less likely to be referred for transplants, less likely to be waitlisted, and less likely to receive organs—even within their own families.
The disparity is not dramatic or visible. It is quiet, routine, normalised. Bioethicist Dr Anant Bhan describes such decisions as being shaped by “expectations, obligations, and power imbalances.” In other words, they are presented as free choices, but rarely exist outside social pressure. This is how inequality operates most effectively, not through coercion, but through internalisation.
India’s transplant infrastructure has expanded. Awareness has improved. Policies have evolved. But the deeper question remains largely unaddressed: not how many organs are donated, but whose bodies are expected to give, and whose lives are prioritised to receive.
Because beneath the statistics lies an uncomfortable truth. In this system, women are not just caregivers. They are givers by design. And when survival itself becomes a question, it is still being quietly decided along the fault lines of patriarchy.
