Patriarchy’s Silent Hand: The Hidden Pressure on Women to Become Organ Donors

Wives, mothers, and daughters-in-law — why are living organ donors in India overwhelmingly women?

Guilt, lack of choice, or a sense of sacrifice – Why are living organ donors in India overwhelmingly women?

(Illustration: Vibhushita Singh/The Quint)

CLICK HERE TO READ THE FULL MULTIMEDIA IMMERSIVE

For 40-something Kavita (name changed), a Bengaluru-based startup professional, there was 'no real choice'. When her father-in-law needed a kidney transplant, her entire family turned to her to step in. 

"There was no question of my mother-in-law donating because she didn't meet the age criteria and was diabetic. My husband was on a project in Germany. I had given birth a couple of years ago. Everyone said that I was free to decide. But even today, I wonder what would have been the reaction had I chosen not to donate. It didn't really feel like I had a choice."

Kavita (Name changed)

Kishan Rastogi (name changed), a patient at Apollo Hospitals, Navi Mumbai, says he 'owes his life' to his 44-year-old wife Rashmi.

A frail-looking Kishan has been suffering from liver-related ailments for the last six years, and Rashmi's willingness to readily donate a portion of her liver for her husband made the difference between his life and death.

Rashmi and Kishan come from a typical 'middle-class' family, striving to make ends meet through their local grocery shop. As the couple waited outside the doctor’s room for their appointment, Rashmi kept checking on her husband.

"There are not many people in his family. His parents are old, and he doesn't have any brothers. He has a sister, but she has her own family, and we cannot ask her. My kids are also young. There is no one else but me to save my husband."

Rashmi

Mothers, wives, daughters, and daughters-in-law – there is a pattern when it comes to living organ donation in India . A staggering majority of them are women.

Data & Organ Donation: Women Give, Men Receive

Although there is no centralised data for living organ donation in India, doctors at three different hospitals point out that women consistently outnumber men when it comes to donating organs for their male relatives – a trend seen across years, cities, and hospitals.

Nephrologists at Osmania General Hospital (Hyderabad), Manipal Hospital (Karnataka), and Apollo Hospitals (Navi Mumbai), say that approximately “70-80 percent of donors are women” and “70 percent of the recipients are male.”

Data source:  Osmania General Hospital (Hyderabad), Manipal Hospital (Karnataka), and Apollo Hospitals (Navi Mumbai).

(Photo: The Quint)

A Right to Information (RTI) application filed by writer Shohini Chattopadhyay in 2018 remains the only available government data on living organ donation till date. According to the data, between 2008 and 2017, women constituted 74 percent of kidney donors in three centres. Women also constituted 60.5 percent of donors for liver transplants in five centres between 2009 and 2017.

Data from the National Organ and Tissue Transplant Organisation (NOTTO), meanwhile, revealed that four out of five organ donors in India between 1995 and 2021 were women, and four out of five people who received the organs were men.

Why Women Donate (Part 1): The Guilt Factor

When 35-year-old Chennai-based teacher Leela's son was diagnosed with renal failure at age nine, her first reaction to the news was 'a gnawing guilt.'

"I remember how I was crying for almost one week. I kept thinking I should have asked him to drink more water, I should have fed him better. The only way I could set this straight was by giving my son a second life. There was just no way I would trust anyone else with it."

Leela

Leela lives in an upper-middle class housing society in Chennai's Alwarpet. Today, a 12-year-old, her son is like any other pre-teen, says Dr S Srinivasan, who has over 20 years of experience, and was their consultant since the diagnosis and transplantation in 2019.

"Mothers, especially of young children, always think that what has happened to their child is because they did something wrong. They feel they should have noticed the symptoms earlier, or they could have done something better. From my experience, the mother, in most cases, doesn't even wait for a minute before she asks how she can donate."

Dr S Srinivasan, Nephrologist, Chennai

Guilt also played a role in Vasundhara Raghavan's journey as a donor to her child. Recalling her teenage son's childhood, she says she regrets not taking a second opinion on his tendency to wet the bed – a symptom that could have indicated that his kidney function needed attention.

"My son used to wet the bed until he was about 10. I took him to a family physician who just told me this would correct itself with age. But it was much later that I came to know that had I caught the issue five years earlier, we could have dealt with it through reconstruction surgery. Instead, we had to put him through dialysis and later a transplant. Yes, the mothers always feel more guilty." 

Vasundhara

But Vasundhara’s decision to donate wasn’t an easy one. It all started in 1996, when her then 15-year-old son in Mumbai was repeatedly complaining of headaches, which his mother thought was a tactic to skip school. Little did Vasundhara know that her life was about to change forever.

Her son was diagnosed with renal failure, and Vasundhara was cleared to donate a kidney after several careful tests. But fate had other plans.

Just two days after she was permitted to donate, Vasundhara was diagnosed with breast cancer.

"My eldest son persuaded me not to donate. He said he would donate instead. I said no. I wanted at least one child to go ahead, finish their education, and survive. My younger son was probably wondering if he would even get a kidney like it was promised by his mother. It is not a good feeling. It was all hanging like a question mark."

Vasundhara

In 1998, she donated one of her kidneys to her son. Today, 75-year-old Vasundhara passionately runs the Kidney Warriors Foundation, India's first non-profit NGO that works to assist families with a member suffering from kidney ailments. Following a successful transplant, her son now dons several hats – a chef, scientist, writer, and a celebrated cheesemaker – all because of his mother.

Why Women Donate (Part 2): The Physiology

There is also a scientific reason why mothers are more likely to donate to their children.

"We also take other factors into consideration like size, health, and well-being. Usually, women tend to be shorter, smaller, and more petite, so we're more likely to get a better size metrical with the mother compared to the father. But if the child is 25-30 kg, then sometimes, it may turn out that the mother is too petite for that."

Professor Darius Mirza, Consultant and Multi-Organ Transplant Lead, Apollo Hospitals, Navi Mumbai

Why Women Donate (Part 3): The 'Worth' of Their Bodies

“Women generally have a sense of sacrifice. Many of them are not working, so they come forward to donate because the male member is usually making money for the family. Because of patriarchy, they give a lot of importance to male members.”

Dr Manisha Sahay, Head of Nephrology, Osmania General Hospital, Hyderabad

In Pune, 38-year-old Shreya Pawar, who was working at a travel agency, took the call to donate a kidney for her 45-year-old husband earlier in 2023, because it was the "right decision for her family".

"There was no other way. We asked my two brothers-in-law but they said no. If I didn't step in, who would feed my family? Today, he has recovered and is back at work. I had to quit my job to donate and take care of his recovery. But he earns more, and this was a good decision for us in the long run," said Shreya.

According to experts, financial dependency is a major reason we don't see many fathers donating. To go through the organ donation process, men have to take the time to get screened, do several tests, and take time for the recovery period which is often not financially viable in a household where the husband is the primary breadwinner.

Though most liver donors do not experience serious or long-term complications, recovery can take time.

In the case of liver transplants, doctors recommend that the donor stays in the hospital for at least four to five days. It would, however, take at least six and up to eight weeks for the incision to heal properly. Most can resume work within three to four weeks of the surgery.

"In a nuclear family set-up, the wife, who is financially dependent on the husband, or where the husband is the breadwinner, there is little choice. The wife always comes forward to donate. In my 15 years of observation, in spousal donations, in most cases when the wife comes forward, she is dependent on the husband."

Dr Vivek Kute, Professor and Unit Head, Nephrology and Transplantation, Institute of Kidney Diseases and Research Center, Ahmedabad

Is There A Way to Fix the Gap?

In the United States, which performs the most number of living organ transplant surgeries, women constitute 62 percent of kidney donors and 53 percent of liver donors.

According to the World Health Organisation (WHO), India is only behind the US in performing and emerging as a hub for such transplants.

While improving Indian women's current employment rate of 23.97 percent is a long-term solution, which will impact other factors centring patriarchy, the more practical solution would be to encourage cadaveric donors, say experts.

India’s organ donation rate stands at 0.52 per million population.

In Spain, the rate is 34 per million population, the highest in the world. This is approximately 67 times the rate in India.

Every 10 minutes, at least one more person is added to the waitlist of people who need an organ donation. Over 3 lakh people are already on the waitlist. At least 20 people die each day while on that waitlist.

But what happens when it is the woman who needs the kidney?

They are not really prioritised by their families, say experts. Out of the total 36,640 patients who underwent (any) organ transplants between 1995 and 2021, 29,695 were men, NOTTO data showed.

So, if there are no living organ donors – or as in case of India, no mothers, wives or daughters to make the 'sacrifice' – the chances of dying while waiting for an organ are almost inevitable.