"NOTTO portal and swap guidelines aim to reform organ transplant governance"
NOTTO
National Organ and Tissue Transplant Organisation; apex body for organ procurement and allocation under THOTA
THOTA
Transplantation of Human Organs and Tissues Act, 1994 (amended 2011); primary legislation governing organ transplants in India
Organ transplantation in India is governed primarily by the Transplantation of Human Organs and Tissues Act (THOTA), 1994, which was significantly amended in 2011 to expand the definition of 'near relatives', permit swap transplants in principle, and strengthen the regulatory framework. The Act established a tiered regulatory architecture: the National Organ and Tissue Transplant Organisation (NOTTO) at the apex, supported by Regional Organ and Tissue Transplant Organisations (ROTTOs) and State Organ and Tissue Transplant Organisations (SOTTOs), each responsible for coordinating procurement and allocation within their jurisdiction. Constitutionally, health is a State List subject (Entry 6, List II, Seventh Schedule), which means transplant regulation involves significant Centre-State coordination — a structural challenge that has historically produced uneven outcomes across states.
India's deceased donation rate — less than one per million population (PMP) — remains among the lowest globally, compared to Spain's rate of over 40 PMP. This gap is not merely a medical or logistical problem; it reflects deep-seated cultural hesitancy, inadequate infrastructure for brain-death certification, and a lack of public trust in the allocation system. Tamil Nadu has long been an outlier, having built a robust state-level coordination mechanism that has become a national model. The National Organ Donation Day is observed on August 3, marking the anniversary of India's first successful heart transplant performed at AIIMS New Delhi in 1994.
The organ allocation system in India operates on a hierarchical priority principle: when an organ is harvested at a centre, the first right of allocation goes to that centre's own waiting patients, then to nearby hospitals, then to others in the state, then regionally, and finally nationally if no match is found at lower levels. This cascade is designed to minimise cold ischaemia time (the period an organ can survive outside the body) while ensuring equitable access. The NOTTO portal now digitises this entire cascade, creating hospital-level, state-level, and national waiting lists that are visible to all stakeholders — patients, hospitals, state authorities, and NOTTO itself.
A critical feature of the portal is the 'super urgent' status flag, which allows hospitals to escalate a patient's priority when their condition deteriorates rapidly. The portal also enables hospitals to constitute mandatory committees — the Hospital Authorisation Committee and the Brain Death Certification Committee — digitally, which is significant because inadequate brain-death certification has historically been a bottleneck in deceased donation. …
Consider the following statements:
Statement-I: India's public sector health care system largely focuses on curative care with limited preventive, promotive and rehabilitative care.
Statement-II: Under India's decentralized approach to health care delivery, the States are primarily responsible for organizing health services.
Which one of the following is correct in respect of the above statements?
With reference to Ayushman Bharat Digital Mission, consider the following statements:
1.Private and public hospitals must adopt it.
2.As it aims to achieve universal health coverage, every citizen of India should be part of it ultimately.
3.It has seamless portability across the country.
Which of the statements given above is/are correct?
With reference to the organ transplant regulatory framework in India, consider the following statements:
1.NOTTO functions as the apex body for organ procurement and allocation under the Transplantation of Human Organs and Tissues Act.
2.Under the allocation cascade, the first right to an organ harvested at a centre goes to hospitals in the same state.
3.Health is a State List subject under the Seventh Schedule of the Constitution.
Which of the statements given above is/are correct?
Which of the following best describes 'swap transplantation' in the context of organ donation?
Assertion (A): Swap transplantation in India currently exists in a legal grey area.
Reason (R): The Transplantation of Human Organs and Tissues Act and its Rules do not explicitly govern swap transplant procedures.
Which one of the following is correct?
With reference to the NOTTO digital portal launched recently, which of the following features does it include?
1.Allowing patients to file grievances regarding their transplant case status
2.Enabling hospitals to flag a patient's status as 'super urgent' when their condition deteriorates
3.Mandating all private hospitals to register on the portal within a fixed timeline
4.Creating a national waiting list visible to NOTTO for organ allocation
Select the correct answer using the codes below:
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