On a busy Friday in Mumbai, organ donation coordinators worked tirelessly after the family of a 49-year-old man, declared brain-dead at Fortis Hospital in Mulund, consented to donate all his organs. This generous decision had the potential to save up to eight lives, bringing hope to many awaiting transplants.
The Reality of Organ Utilization
Despite the family's willingness to donate multiple organs including the pancreas and hands, coordinators from the Zonal Transplant Coordination Centre (ZTCC) could only find recipients for his liver and kidneys. "The family consented to donate his pancreas and hands as well, but no hospital had a recipient ready for the operation," explained Dr S Mathur of ZTCC, which manages organ distribution in Mumbai through a computer-based points system.
Consent Numbers Versus Actual Retrievals
The new year began positively with seven families consenting to donate organs of brain-dead relatives, marking a significant increase in a city that saw an 11% drop in cadaver donations from 60 in 2024 to 53 in 2025. January 2026 started with a 46-year-old female's family donating her lungs, heart, liver, and cornea. However, subsequent donations yielded only liver and kidneys from six donors.
So far in January, ZTCC has received consent for 26 organs, but only 18 could be retrieved. "There is always a difference in the number of organs consented to be donated and the actual utilization," noted Dr Mathur. Reasons include organs not being optimal for transplantation or recipients facing issues like slight fever or lack of funds for surgery.
Systemic Challenges in Transplant Coordination
A senior doctor, who wished to remain anonymous, suggested another explanation: hospitals may seek consent only for organs they specialize in transplanting. "Why would a hospital not known for pancreas or hand transplants seek consent for these organs? It's a fractured system," the doctor alleged.
The Hand Transplant Dilemma
This issue is particularly evident in hand transplants. Dr Nilesh Satbhai, a plastic surgeon at Nanavati Hospital in Juhu who has performed 26 hand transplants for over 13 patients, revealed that all hand donations for his operations came from outside Mumbai, with none from the city itself. In the past five years, only three hand donations in Mumbai were assigned to patients at Parel's BMC-run KEM Hospital.
On January 9, Dr Satbhai performed a rare hand transplant where a 20-year-old boy from Rajkot, who lost his arms in a farm accident, received arms from a 50-year-old woman from Surat. "The boy is healing well," he reported. However, transporting the hands from Surat to Mumbai via flight increased costs due to the need for timely reattachment. "Local donations would mean lower costs for the patient," he added.
Broader Context of Organ Donation in India
Organ donation in India has always lagged behind the demand from patients with organ failure. In August 2025, the Union Health Ministry acknowledged that while India ranks third globally in total organ transplants, behind the US and China, its donation rate remains under 1% relative to the population. Health officials highlighted that over 63,000 individuals need kidney transplants and around 22,000 require liver transplants.
Public Hospital Challenges in Mumbai
Mumbai, which pioneered India's cadaver transplant program in 1997, faces challenges in public hospitals, which rarely register donations. "One needs a system in place, transplant coordinators, and ICUs that can maintain a brain-dead patient, but clearly this isn't happening with our public hospitals," a doctor pointed out.
The gap between consent and utilization underscores the need for a more robust and integrated transplant ecosystem in Mumbai and across India, aiming to bridge the divide between donor generosity and recipient access.
