🎗Estimating the scale of unmet solid organ transplantation need in India: a demographic scenario analysis to 2040

Background: Solid organ transplantation (SOT) is the definitive therapy for end-stage
organ failure. Despite the world’s third-highest transplant volume, India has no
systematic assessment of unmet transplant need across organs.
Methods: We modelled 1) Global Burden of Disease 2021 organ-specific disease
incidence. 2) Global Observatory on Donation and Transplantation for SOT data, and
3) IHME demographic projections till 2040. Evidence based eligibility multipliers
(kidney 5%, liver 2%, heart 1%, lung 0·3%), were applied for SOT need. We modelled
four transplant supply scenarios (status quo, pre-COVID-19 trend, moderate reform (8-
10% /year growth), and aspirational expansion) to estimate coverage and unmet
demand.
Findings: In 2021, estimated annual transplant need was 125,894 (95% uncertainty
interval 115,983-136,156) kidney; 184,542 (169,563-198,686) liver; 83,841 (65,602-
99,462) heart; and 11,253 (10,285-11,606) lung transplants. Actual supply met only
7·2% of kidney, 1·5% of liver, 0·2% of heart, and 1·2% of lung need. By 2040, need is
projected to reach 143,722 kidney, 210,649 liver, 95,711 heart, and 12,846 lung
transplants annually. Even under moderate reform, 2040 coverage reaches only 29%
for kidney and remains below for 10% for liver, heart, and lung. In 2024, five states
accounted for 80-96% of SOT despite representing only 29% of the population.
Interpretation: Our report quantifies a large and persistent gap between transplant
need and supply in India. Thus, this study provides a quantitative basis for national and
state-level planning to expand organ donation programs.