India's organ donation framework: How THOTA regulates transplants

India's organ transplantation landscape operates under the Transplantation of Human Organs and Tissues Act, a legal framework that regulates how organs can be donated, allocated and transplanted across the country. The legislation distinguishes between different donation pathways, each with specific approval mechanisms and procedural requirements designed to ensure ethical practice and prevent exploitation.

The system accommodates living donors, who may contribute organs such as kidneys or portions of liver to recipients, as well as deceased donations following brain or cardiac death. A third pathway permits altruistic transplants, where donors contribute organs without expectation of benefit. All categories operate under THOTA's strict oversight to maintain transparency and prevent commercial transactions in human organs.

Central to the framework is the regulation of organ allocation and removal procedures. Medical authorities must follow prescribed protocols before extracting organs from donors, and recipient selection is governed by established criteria to ensure fair distribution. The legislation explicitly prohibits the buying and selling of organs, a critical safeguard against exploitation of vulnerable populations.

Each state in India implements THOTA through designated transplant authorities and accredited medical institutions. These bodies review donation cases, verify donor consent, and oversee the medical procedures involved. The regulatory structure aims to balance the critical need for organ transplants against ethical concerns and the protection of donor rights, establishing India's transplant system as one of Asia's largest in terms of volume.