Published Oct 16, 2026 | 10:30 AM ⚊ Updated Oct 16, 2026 | 10:30 AM
Women accounted for 70.2% of kidney donors in Delhi and 68.1% in Kerala.
Synopsis: Women account for nearly 71% of India’s living kidney donors. However, they comprise only 23% of recipients, according to NOTTO data for 2025. State-wise figures reveal similar disparities across regions. Experts point to possible social and healthcare access barriers, while gaps in registry data limit conclusions about the causes.
In 2025, women donated 1,683 of the 2,397 kidneys transplanted through living donors in Delhi. Women received 555 of those kidneys.
In Keralam, women donated 726 of the 1,066 kidneys transplanted through living donors. They received 252.
The two states differ in their social and economic contexts, yet their transplant figures tell a similar story. Women accounted for 70.2% of donors in Delhi and 68.1% in Kerala. But they represented only 23.2% and 23.6% of recipients, respectively.
The figures from the National Organ and Tissue Transplant Organisation (NOTTO), obtained by South First under the Right to Information Act, raise two connected questions: why do women account for such a large share of living kidney donors, and why do they receive so little?
Dr Manjusha Yadla, Professor and Head of the Department of Nephrology at Gandhi Medical College in Hyderabad, pointed to the expectations families place on women.
“It’s a long-standing issue,” she told South First. “Women are supposed to be serving their families. That patriarchal attitude, particularly in low socioeconomic status households, could be one of the factors.”
Women are often expected to care for relatives who fall ill. That responsibility can extend to donating an organ when a family member needs a transplant. But Dr Yadla cautioned against assuming that every donation reflects coercion.
“The donation is high because of the implied responsibility of family care or whatever. The coercion may or may not exist. We really do not know,” she said.
The distinction matters. The NOTTO figures established the disparity in donation and transplantation. Still, they could not reveal whether a woman made a fully voluntary decision, felt pressure from her family or had the same opportunity as a man to receive a kidney.
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In 2025, women donated 8,835 of the 12,491 kidneys transplanted through living donors across India, accounting for 70.7% of donors. They received 2,835 kidneys, or 22.7% of recipients.
It amounted to about 3.1 women donors for every woman recipient.
National figures from 2019 to 2022 showed that women consistently accounted for 65.4% to 68% of donors. Their share of receiving kidneys ranged from 25.2% to 28.8%. In those years, the number of women donors for every woman recipient ranged from about 2.3 to 2.7.
For Dr Yadla, the donor-recipient disparity could not be understood by looking only at who is willing to donate. The process through which patients reach a transplant centre, complete medical assessments and become eligible for transplantation also matters.
“Women are less listed because they’re not worked up,” she said, referring to the medical evaluation required before a patient can be listed for a transplant.
She said women may face delays in getting to hospitals, completing investigations, and returning for appointments. These are not necessarily medical barriers. Family responsibilities, dependence on relatives for transport and financial constraints can also affect whether a patient completes the process.
“Even if they’re called, they don’t come,” she said, describing situations in which women depend on family members to help them navigate healthcare.
The remark should not be read as blaming women for missing appointments. Dr Yadla’s broader point is that access to treatment can depend on whether relatives support the process.
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A study of 1,171 living-donor kidney transplants at AIIMS New Delhi between 2013 and 2022, published in the Indian Journal of Nephrology in 2026, found that women accounted for 79% of donors. Men represented 81.46% of recipients.
The researchers interviewed 92 women donors to understand the social circumstances surrounding their decisions. About 51.8% cited sociocultural conditioning or their perceived subordinate position within the family. Another 33.2% cited economic dependence or their status as non-earning household members. For 15%, altruism was the sole stated driver.
Mothers accounted for 50.1% of women donors in the study, while wives accounted for 35.6%.
The researchers’ accounts illustrated how family roles influence the decision to donate. One participant said, “In our family, women are expected to put others first; it’s always been this way.”
Another explained the difference between her husband’s role as an earner and her own position at home: “My husband works, and I stay at home. If he got operated on, who would earn? But I could manage.”
A third participant described donating to her son as an instinctive decision: “I didn’t think twice; he is my son. It was natural for me to do it.”
These accounts do not establish that all women who donate face pressure. They do, however, show why researchers need to examine the circumstances in which women make such decisions rather than treating the number of donations as evidence of uncomplicated altruism.
Dr Yadla said assessing voluntariness is particularly difficult when donation is framed as an expression of love and responsibility.
“Out of love and affection I’m giving, we need to agree on that,” she said, describing how a woman may understand her decision. At the same time, she cautioned that the voluntary nature of a decision is difficult to assess objectively.
The AIIMS study was conducted at a single centre in North India. Its findings cannot establish the reasons behind the pattern in every state. But when read alongside the NOTTO figures, the study provides a basis for investigating how social expectations, financial dependence and access to treatment may intersect.
The AIIMS researchers discussed low female literacy and workforce participation as factors associated with the pattern they observed. But the similarities between Delhi and Keralam suggested the disparity shouldn’t be explained by a single social indicator.
In 2025, women accounted for 70.2% of donors in Delhi and 68.1% in Kerala. Their shares among recipients were nearly identical, at 23.2% and 23.6%, respectively.
The comparison does not disprove the AIIMS study. Its findings concern patients treated at one hospital over a decade, while the NOTTO figures describe transplants recorded across states in a single year. The data also identified the state where the transplant took place, not necessarily where the donor or recipient lived. Delhi hospitals, in particular, may treat patients from other states.
Still, the figures showed that the disparity is not confined to one state or one local context.
Dr Yadla said the expectations placed on women within families can influence who donates, including when a wife donates to her husband or a mother to her child. She also pointed to the need to distinguish donations between near relatives and those involving other relationships.
“Is there any concept of exploitation? Is there only the concept of taking care of the family?” she asked, describing questions that cannot be answered from aggregate donor figures alone.
She noted that state-level authorisation committees assess cases involving donors who are not near relatives. But the figures supplied by NOTTO do not include donor-recipient relationships, making it impossible to determine how many women donated to husbands, children or other relatives in each state.
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The five southern states together recorded 4,030 living-donor kidney transplants in 2025, accounting for 32.3% of the national total. Women donated 2,788 kidneys and received 1,024.
Andhra Pradesh recorded the widest donor-recipient gap among the five. Women accounted for 76.9% of donors but only 22.3% of recipients. The state recorded 364 transplants, including 280 women donors and 81 women recipients.
In Telangana, women accounted for 69% of donors and 22.2% of recipients. Of the state’s 594 transplants, 410 involved women donors and 132 involved women recipients. The share of women among donors rose from 54.7% in 2019 to 69% in 2025.
Keralam recorded 1,066 transplants, with women making up 68.1% of donors and 23.6% of recipients. In Tamil Nadu, which recorded 1,462 transplants, women accounted for 67.4% of donors and 27.4% of recipients. Karnataka recorded 544 transplants, with women representing 71% of donors and 29% of recipients.
The figures place Tamil Nadu and Karnataka closer to the national pattern on donation, but with a higher share of women recipients than in Telangana, Andhra Pradesh, Keralam and Delhi. Tamil Nadu also recorded a fall in women’s share of donors, from 75.6% in 2019 to 67.4% in 2025.
Karnataka’s figures require caution. The reported number of donors fell from 633 in 2023 to 245 in 2024, before rising to 544 in 2025. NOTTO has not explained the sharp fluctuation.
Dr Yadla said access to healthcare is central to understanding why women may be underrepresented among transplant recipients. She said that, in her clinical experience, women may not receive the same attention when they report symptoms and may reach hospitals later than men.
“Men have more attention,” she said.
She also cautioned against using hospital records alone to conclude the prevalence of chronic kidney disease among women and men.
“When you speak about the prevalence, I feel it should be in line with true data, rather than biased data or hospital-based data, which just gives us the hospital admissions, which doesn’t speak about the true prevalence of a disease in the community,” she said.
Her point raised a separate research question. The NOTTO data did not show how many women and men in each state have chronic kidney disease, develop kidney failure or are medically eligible for transplantation. Without those denominators, the recipient figures cannot establish whether women are less likely to receive a transplant relative to their clinical need.
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The disparity is not uniform across the country.
Among states that recorded at least 500 transplants in 2025, Uttar Pradesh had the widest gap. Women accounted for 76.2% of donors but only 16.9% of recipients, a 59.4-percentage-point difference.
Gujarat recorded 825 transplants, with women representing 76% of donors and 17.5% of recipients. Rajasthan recorded 556 transplants, with women accounting for 74.8% of donors and 16.7% of recipients. Maharashtra recorded 1,240 transplants, with women representing 74% of donors and 19.5% of recipients.
In each of these states, the difference between women’s share of donors and their share of recipients exceeded the national gap of 48 percentage points.
West Bengal presents a contrasting picture. It recorded 991 transplants in 2025, with women accounting for 52.1% of donors and 31.6% of recipients. The difference, about 20.5 percentage points, was the narrowest among states with at least 500 transplants.
The figures cannot explain why West Bengal differs. They do not reveal the number of women and men who needed a transplant, were referred for assessment, completed the work-up or could afford treatment.
Dr Yadla’s observations suggest why these missing details matter. She said that women’s dependence on family members can affect their access to investigations and treatment, while social expectations may prioritise men as earners.
“Men should be the breadwinner. Men should get the priority,” she said, describing the social expectation she believes can influence healthcare decisions.
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For patients with kidney failure, transplantation requires more than a willingness to undergo surgery. Patients must reach specialist services, complete investigations, find a compatible donor where applicable and return for follow-up. These steps can require time, money and support from family members.
Dr Yadla said women may struggle to complete the transplant evaluation because of these practical barriers. In her account, the assessment process can extend over several weeks, requiring patients to travel between home and hospital.
“All these are inherent logistical challenges which push women not to opt for a transplant, not to get enlisted,” she said.
She also pointed to the costs and travel associated with dialysis. Women who need regular treatment may depend on relatives to take them to a dialysis centre, sometimes travelling 20 to 30 kilometres. Even when treatment is subsidised, transport and other out-of-pocket expenses can add burdens.
Dr Yadla said access to dialysis in Telangana had improved, in her experience, as awareness and affordability increased. She argued that reliable financial support and easier access to treatment could also help women access transplantation.
“If we can cover all these, making universal health coverage a strict and foolproof method, making certain patient incentives available, it definitely will encourage women also to access renal replacement therapies, whether it’s haemodialysis or transplant,” she said.
Her observations underlined the need to look beyond the final transplant count. The gap may reflect different stages of the healthcare pathway, from recognising symptoms and reaching a hospital to completing evaluation and receiving a transplant. The current registry data cannot show at which stage women are being lost.
In a commentary published in the Indian Journal of Nephrology on 25 June 2026, Mythri Shankar of the Institute of Nephro-Urology, Bengaluru, and Ranjanee Muthu of Apollo Hospitals, Chennai, called for research into the social pressures surrounding living kidney donation, its long-term medical and psychological consequences, and stronger informed-consent and family-counselling processes.
“Making a more just transplant system a reality requires not only awareness but also actual societal and structural transformation,” they wrote.
The NOTTO data did not record donor-recipient relationships, the number of patients assessed or listed for transplantation, or the reasons patients did not proceed. They also do not establish whether donors experienced pressure to donate.
The registry has reporting limitations. NOTTO told South First that transplant and retrieval hospitals supply data to the National Registry, and some centres or states do not provide information in the prescribed format.
The October 2026 reply also contained inconsistencies. Its printed annexures appeared to shift state rows for 2024 and 2025: Daman and Diu is listed with 2,410 donors in 2024, a figure matching Delhi’s reported count, while Kerala appears with zero. The 2023 national recipient totals also do not match the sum of the state-wise figures. These discrepancies require clarification.
This analysis therefore used the 2025 state-wise figures and national sex-disaggregated data for 2019 to 2022, excluding the inconsistent recipient breakdowns for 2023 and 2024.
Dr Yadla said hospital-based figures alone cannot establish the prevalence of kidney disease in the community. She called for more representative data to understand differences in disease burden and access to transplantation.
“When you speak about the prevalence, I feel it should be in line with true data, rather than biased data or hospital-based data, which just gives us the hospital admissions,” she said.
The available figures established a disparity in living kidney donation and transplantation, but do not explain its causes. Data on disease prevalence, referrals, medical assessments, transplant listing and donor-recipient relationships would help researchers examine where differences arise.
In 2025, women donated 8,835 kidneys and received 2,835. Understanding that gap requires data showing not only who donates and who receives a kidney, but also who needs a transplant and who reaches the point of receiving one.
(Edited by Majnu Babu).
