TN leads in organ transplants despite long waiting list: Dr N Gopalakrishnan

Tamil Nadu’s strength lies in building an organised and decentralised transplant ecosystem. In 2024, the State recorded 268 deceased donors, contributing 23.1% of India’s total deceased donations. In 2025, despite a marginal decline to 266 donors, Tamil Nadu still accounted for 20.4% of the national performance. More importantly, organ donation is no longer confined to Chennai or a handful of tertiary hospitals. Every district now contributes to the programme, reflecting the maturity of the system and the awareness created among healthcare professionals and the public.

The backbone of our programme is the active participation of government hospitals. Brain-dead patients are identified through a structured clinical pathway, families are counselled sensitively, and donor organs are allocated through a completely transparent, digital and real-time monitoring system. Every stage of retrieval and allocation is evidence-based and closely supervised. Many States still depend largely on a few metropolitan centres, whereas TN has institutionalised the programme across districts. That’s why our model has been widely appreciated and replicated.

Affordability has been one of our biggest priorities. Tamil Nadu became the first State in the country to provide financial assistance of up to Rs 22 lakh for any organ transplant under the Chief Minister’s Comprehensive Health Insurance Scheme. So far, 588 patients with end-stage organ failure have benefited under the scheme. Today, 12 GHs perform kidney transplants, 3 undertake liver transplants and 2 carry out heart transplants. Empanelled private hospitals also provide transplant services under CMCHIS, ensuring that financial constraints do not become a barrier to life-saving treatment.

Tamil Nadu was the first State to streamline organ allocation and establish clear medico-legal protocols for organ donation from brain-dead donors. We also pioneered several combined transplant procedures, including pancreas-kidney, liver-kidney and heart-lung transplantation. Our GOs have served as reference documents for several States and even the GoI. The programme has received the GoI’s Best State Award for Organ Donation and Transplantation 6 consecutive times and has also earned recognition from Guinness World Records and the Asia Book of Records for large-scale public awareness initiatives.

Since the inception of the programme, transplantation has been performed for 12,413 patients. These include 3,727 kidney, 1,887 liver, 944 lung, 933 heart, 44 pancreas, 21 small bowel and seven hand transplants, besides thousands of tissue donations involving corneas, heart valves, skin, bone, blood vessels, spinal tissue, abdominal flaps and stomach tissue. Despite this progress, demand continues to outpace availability. The active waiting list includes 8,539 patients awaiting kidneys, 693 patients needing livers, 86 waiting for hearts, 6 for pancreas and 8 for small bowel transplantation. Waiting time varies according to blood group compatibility, medical urgency, associated illnesses and donor availability. The COVID-19 pandemic also disrupted transplant activity, adding to the existing waiting list.

The rise is closely linked to changing disease patterns. Diabetes, hypertension and obesity remain the leading causes of chronic kidney disease and heart failure. Environmental factors such as air pollution, chemical exposure and prolonged heat stress are further aggravating the burden. We’re increasingly seeing kidney damage among agricultural workers, construction labourers and others employed in the unorganised sector who spend long hours working under extreme heat. These trends underline the need to view organ failure not merely as a surgical issue but as a broader public health challenge.

Under the One Nation One Organ policy, patients from different parts of India, including migrant workers residing in Tamil Nadu, register here because they have confidence in the State’s transparent allocation system and robust transplant infrastructure. While greater organ availability encourages registrations, it also lengthens the waiting list. That challenge is not unique to Tamil Nadu; every country faces a gap between organ demand and donor availability. Ultimately, transplantation should not be viewed as the complete solution. It’s one component of the continuum of care. The real priority must be preventing organ failure by controlling diabetes, hypertension and obesity, promoting healthier lifestyles and ensuring early diagnosis. As of June 30, 2026, Tamil Nadu had already recorded 176 deceased donors, with Government Rajaji Hospital, Madurai leading the State with 18 donors, followed by Government Medical College Hospitals at Dharmapuri and Tirunelveli with 13 donors each. Those numbers reaffirm that Tamil Nadu’s strength lies not merely in performing transplants, but in sustaining a public health model that continues to save lives and set national standards.