Ever since the inception of the National Organ and Tissue Transplant Organisation (NOTTO), the number of organ transplants in India has been on the rise, hitting a new high every year — aside from a dip during the Covid-19 pandemic.Over 20,000 transplants were conducted across the country in 2025, the highest so far, according to annual data shared by NOTTO on Monday (August 3) on the occasion of National Organ Donation Day. A majority of these transplants — 16,612 — were performed using organs donated by the patient’s living relative or close friend, while another 3,526 were conducted using organs altruistically donated by families of unrelated deceased donors.While the total number of transplants have been on the rise, the number of deceased donations continue to remain low — less than one per million population.NOTTO also launched its new web portal and mobile application to ensure organ allocations and other tasks conducted by the regulatory body are done transparently. It also released important guidelines on conducting swap transplants.Here are the key findings from NOTTO’s annual data, why the new portal matters, and what the two important guidelines entail.What annual data showsPremier institutes falling short: Only 387 of the 20,000-plus transplants conducted across India happened in the 11 All India Institutes of Medical Sciences (AIIMSs) that offer the facility. The highest numbers were at the oldest New Delhi institute.Most of the transplants conducted across the AIIMS were for kidney (368), followed by liver (16) and heart (3). Also, most procedures used organs from living relatives.Story continues below this adOf the 368 kidney transplants, 326 used living donors. This is surprising, considering NOTTO usually favours government centres for allocation of organs from deceased donors. Also, AIIMS New Delhi did not conduct a single heart transplant in 2025. This is the same institute where India’s first successful heart transplant was performed by Dr P Venugopal on August 3, 1994 — that day is observed as National Organ Donation Day. A 35-year-old patient in the ICU after a successful heart transplant at AIIMS. Photo: Express archiveGender divide: While most of the organs are donated by women, men make up the major chunk of recipients. This trend continued in 2025: of the 16,614 living relatives who donated organs last year, 11,316 (68%) were women. Of the 16,611 people who received organs from a living donor, 12,903 (78%) were men.When it came to kidneys, women made up 71% of donors and 23% of recipients. In the case of liver, 60% donors and 21% recipients were women.Story continues below this adAlso read | Over 1,500 foreign nationals had organ transplants in IndiaState-wise break-up: The highest number of organ transplants were conducted at centres in Delhi (4,564), Tamil Nadu (2,796), and Maharashtra (2,136). Most of the transplants in Delhi, however, happened using organs from living relatives — only 103 transplants were conducted using organs from deceased donors.The highest number of transplants with organs from deceased donors were conducted in Tamil Nadu (804), Telangana (601), and Karnataka (575).This year, Tamil Nadu was felicitated for its contributions. Health Minister K G Arunraj told The Indian Express that this was possible because of the trust built in the system over years. He said that although most of the transplantation centres were in the private sector, the mechanism has ensured transparent allocation and processes.NOTTO has created a one-stop digital solution that can be used by all stakeholders, including the patients, hospitals, state authorities, and coordination networks to ensure transparent functioning of the body and allocation process. Story continues below this adThe portal allows already registered patients to get updates on their case and file any grievance. It allows hospitals to register patients, update their status to “super urgent” in case of deteriorating health, record outcomes of the transplantation and health parameters during follow-up, and raise alerts regarding organ availability. The hospitals would be able to see a hospital-level waiting list. It also allows them to set up various committees such as hospital authorisation committee and brain death certification committee as needed.Also read | Nearly 3,000 Indians died waiting for organs in 5 years; over 82,000 still on transplant waitlistThe portal allows the state appropriate authority to give new or renew licences for transplant centres and address any grievance. For the state-level coordinating body, the portal creates a state-level waiting list and organs can be allocated accordingly when they become available. The first right of any organ harvested at a centre goes to it, followed by hospitals close to it, then hospitals in the state, followed by those in the region and then across the country, if a match is not found at the regional level. The functioning is similar for the regional-level coordinating body.A waiting list will also be created nationally that can be used by NOTTO to allocate organs. All data generated across the network will also be visible to NOTTO.Swap transplantationA swap transplantation is when two or more pairs of recipients and willing, unmatched donors exchange the organs to ensure everybody receives the best match. While it is already carried out by several centres, there is a legal grey area with the current Transplantation of Human Organs and Tissues Act (THOTA) and guidelines governing transplants not saying anything about such swaps.Story continues below this adThe recently released guidelines is essentially a compendium of expert recommendations, with NOTTO needing to make certain changes in the Act and Rules to govern such transplants in black and white. One of the key recommendations is to match such donor-recipient pairs nationally. At present, most swap transplantations in India are single-centre, with only 1% of all transplant centres conducting multi-centre swap, very few including swap across state borders. While the new portal will create a national waiting list automatically, NOTTO also plans to use it to match donor-recipient pairs for a swap. NewsletterFollow our daily newsletter so you never miss anything important. On Wednesday, we answer readers' questions.Subscribe“At present, swap donors are matched by the hospitals. The number of such willing donors is limited at a hospital. Nationally, however, there are about a lakh patients on the waiting list. Finding a matching donor for such a swap would be much easier in the bigger pool,” Dr Anil Kumar, director of NOTTO, told The Indian Express.“While the matching can be done as per the national list, all authorisation process that is followed for all other transplants will also be followed for this as well,” he added.Story continues below this adAlthough Karnataka has created an administrative framework by issuing the Karnataka Multi-Pair Kidney Paired Exchange (Swap) Transplantation Guidelines, 2026, experts have said such transplants should be formally recognised in the THOTA and Rules to prevent hesitation.The experts have also recommended that NOTTO create a pathway where a single authority — in the state of the transplant centre — approve swap transplants across state borders and not both authorities as is the current practice. It also states that a standardised list of documents be created that would be accepted by all states for such transplants, including ID proof, relationship proof, and documents certifying incompatibility with respective donors.