Organ Allocation Process in India

Health is a State subject in India and therefore each state has its own Nodal Agency in charge of the allocation of human organs. Each Nodal Agency is connected to all the Transplant Hospitals in the State. All hospitals are required to have their own website linked to the State Nodal Agency so that the hospital waiting lists for all organs is automatically linked to the State Nodal Agency. State Nodal Agency needs to be linked to the concerned Regional Organ & Tissue Transplant Organisation (ROTTO) and that ROTTO lists in turn are to be linked to the National Organ & Tissue Transplant Organisation (NOTTO). This will form the National Waiting-List Registry.

In the event of a brain stem death, once the family has agreed to organ donation, the hospital informs its own Nodal Officer in charge of organ donation about the death and the willingness of the family to donate. Of the paired organs such as kidney and lungs, one each is used by the hospital for its own patients on the waiting list and the other is given to the common pool and will be allocated by the Nodal Agency to one of the patients in the other hospitals.

The rest of the organs (heart, liver, intestines, and pancreas) can be used by the donor hospital if the hospital is registered to perform those particular transplants and if they have patients on the waiting list. If they do not, then the organs are also given to the common pool and the Nodal Agency will decide their distribution. It is extremely rare to have all recipients in the same hospital, and the organs are usually put in the common pool and allocated accordingly.

As per the government’s allocation policy, if organs are retrieved from a government hospital and put into the common pool, then they will be offered to a government hospital first and then to a private hospital in case there are no takers in the government hospital. If the organs are retrieved from a private hospital, then they will be offered to a private hospital first.
In the event of a trans-state allocation, the concerned ROTTO as well as NOTTO will be informed and they will oversee the allocation of the organs. For policy related further details, please visit