Patriarchal Mindsets Impact Live Organ Transplants in India

As in most aspects of life in India, in live organ donation there is a stark gender gap between women and men, according to data collated by the Ministry of Health and Family Welfare’s National Organ and Tissue Transplant Organization (NOTTO).

Of the 36,640 live organ transplants in the country between 1995 and 2021, 29,695 recipients were male and 6,945 were female. This means that four out of five live organ recipients in this period were men. Women comprised just 18.9 percent of the recipients – although almost 80 percent of live organ donors in this period were women. 

“What the data of recipients shows is that the number of women undergoing transplants is disproportionately low,” said Dr. Anil Kumar, director of NOTTO. “We have to assume that the prevalence of conditions leading to the need for transplants affects men and women at a similar rate. If women who need transplants are not getting treated, it is definitely an issue,” he added.

In an article, “India: Gender Disparities in Organ Donation and Transplantation,” in the June 2022 issue of the journal “Transplantation,” by Vivek B. Kute et al note that women live organ donors are “most frequently mothers (33.7%), wives (20.1%), and infrequently daughters (0.4%).” When parents are donors, 63 percent of them are the mothers of the recipients. Grandparents are infrequently donors because of age and age-related comorbidities. But if a grandparent is a donor, in 78 percent of the cases it is the grandmother who donates her organ.

As an editorial in Times of India noted, there is “an overwhelmingly one-sided flow of organs from mothers and wives to husbands and sons” in the country.

The implications of the gender gap in live organ transplants for the health and survival of women in India are particularly large since the overwhelming majority (93 percent) of all organ donations in the country are from living donors. What is more, live organ donations in India are mostly completed within the family. The serious gender gap in live organ donation in India reflects just how severely skewed gender relations are within Indian families.

The gender gap in live organ donation is not peculiar to India. A study in six Asia-Pacific countries – Australia, India, Japan, the Philippines, South Korea, and Taiwan – that was published in the January 2023 issue of Transplantation revealed that except for the Philippines, female living donors comprised over 60 percent of organ donors in all the surveyed countries. This is the case in Western societies as well where gender inequality is less pronounced. In the United States, for instance, between 2008 and 2017, women comprised 62 percent of kidney donors and 53 percent of liver donors.

Clearly, there is a bias in favor of men in live organ donations in countries across the world. However, the bias is particularly pronounced in India.

In deeply patriarchal India, women face prejudice and discrimination at every stage of life. Indeed, the odds are heavily stacked against a woman’s survival from the time she is in the womb. The chances of survival of a female fetus are less than that of a male, evident from the skewed sex ratio at birth in the country. Although sex-selective abortion is banned in India, female feticide continues to be practiced. 

Whether with regard to nutrition, literacy or employment, girls and women are worse off than boys and men. It is daughters, sisters, mothers, and wives who are the last in a family to eat, the first to be pulled out of school, and less likely to receive medical treatment. The life of a woman is less valued than that of a man. Families are less likely to devote scarce resources to her health and well-being but do not think twice about expecting her to donate an organ to a male family member.

An explanation often given for the gender gap in live organ donation is the economic one. According to the article by Kute et al, “With men being frequently the only ‘bread-winner’ in the household, the loss of income during evaluation, surgery, and recovery, particularly for low-income households, ‘prevents’ men from donating and the wife is consequently ‘pushed’ to be a donor. Indeed, family pressure on females mounts. It is thus not at all uncommon to see undue coercion and pressure for women to donate.”

Since the man is seen to be the “breadwinner” in the family, his health is seen to be vital to the financial survival of the family. However, even in cases where women of the family are engaged in paid labor and contributing to the family income, the survival of the men appears to be more valued. The life and longevity of a woman is less important than that of a man.

There is social pressure on women to step forward to donate their organs. The gender stereotype of women as the nurturing caregivers in the family is so deeply ingrained in women that more often than not women volunteer to donate their organs. Women feel guilty when they do not donate their organs. Men do not come under similar social pressure.

Interestingly, it is often a wife who donates an organ for her husband, even when he has a brother who may be a more suitable donor.

One way out of the discrimination against women in live organ transplantations is to turn to cadaver transplants. Cadaver organs are distributed based on a waitlist that patients enroll in. A patient gets an organ irrespective of gender. By encouraging more cadaver organ donation, the burden on women to donate organs can be reduced.

More importantly, India needs to tackle its deep-rooted prejudice against women. It underlies many of its problems, not just those relating to organ transplants.