The Supreme Court of India has directed the Union government, through the National Organ and Tissue Transplant Organisation (NOTTO), to evolve model national guidelines to address critical concerns regarding gender, class, and regional disparities in organ transplantation. The court's directive, issued on Wednesday, November 19, 2025, emphasizes the need for a transparent, efficient, and equitable system for organ donation and allocation across the country.

A bench comprising Chief Justice B.R. Gavai and Justice K. Vinod Chandran passed the directions while hearing a Public Interest Litigation (PIL) filed by the Indian Society of Organ Transplantation. The court underscored that a uniform national policy on organ donation is imperative to secure the health of citizens, addressing the constitutional obligation to provide equal access and opportunity to all recipients, irrespective of their socio-economic background, gender, or place of domicile.

The court has instructed the Centre and NOTTO to establish a five-year plan to ensure that organ transplantation facilities are available in public hospitals in all states. This initiative aims to bridge the gap in medical facilities, particularly in states like Manipur, Nagaland, Andaman and Nicobar, and Lakshadweep, which currently lack a State Organ and Tissue Transplant Organisation (SOTO).

The Supreme Court has mandated the creation of model allocation criteria to ensure equal opportunities for all organ recipients, regardless of their social status, gender, or region. To facilitate this, the Centre has been directed to develop a national web portal that compiles relevant information. This portal will serve as an accessible platform for individuals to track their position on the waiting list and understand their chances of receiving a transplant, promoting transparency and accountability.

The court has also addressed the exploitation of live donors, directing the Centre to develop guidelines for their welfare, ensuring post-donation care and preventing commercialization and exploitation. Furthermore, the government, in consultation with NOTTO, has been instructed to amend birth and death registration forms (Form 4 and 4A) to explicitly indicate whether a death was a "brain death" and whether the option to donate organs was presented to the family.

The Supreme Court has also stressed the importance of standardized regulations to address the existing disparities in organ donation practices across states. It has directed NOTTO, in consultation with the states, to develop a uniform policy for patient registration, organ and tissue allocation criteria, and uniform registry formats, applicable throughout the country.

The court has expressed concern over the underreporting of organ transplant data by hospitals and has directed all states to ensure that hospitals report data related to organ donation and transplantation, along with the details of donors and recipients, to the national registry maintained by NOTTO. Strengthening enforcement against non-compliant hospitals is also a priority.

The court acknowledged that Andhra Pradesh is the only state that has not yet adopted the amendment to the 2011 Act, which enabled swap transplantation for the first time, expanded the definition of 'near relatives,' and established a National Registry for Transplants. The Chief Justice urged the Centre to persuade the state to adopt the amendments. Additionally, Karnataka, Tamil Nadu, and Manipur have not adopted the Transplantation of Human Organs and Tissues Rules, 2014, and the court has directed the Centre to ensure these states implement the rules expeditiously.

Justice Chandran highlighted disturbing reports of abuse in organ procurement, citing instances of "motivated accidents" staged to supply organs to specific recipients. Solicitor General Tushar Mehta agreed with many of the petitioner's recommendations but suggested that the rules may need to differentiate between standard cases and those where organs are taken from individuals who die in accidents.

The Supreme Court's directives signal a move towards a unified, rights-based national system for organ transplantation, addressing inequities and ensuring that all citizens have equal access to life-saving procedures.