ArticleThe Lancet regional health. Southeast Asia2026
Scale of unmet solid organ transplantation need in India: a projection for organ transplant need by 2040.
Article in The Lancet regional health. Southeast Asia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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 (flat supply, 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 32.6% for kidney and remains below 7% 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. Funding: None.
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