Organ Donation Law in India: How THOTA Works, Altruistic Donation and Penalties

In late September 2026, the Karnataka High Court allowed a 52-year-old man to donate one of his kidneys to a recipient he is not related to. The state government told the court it is drafting guidelines for handling such altruistic donations. The case is a good moment to look at how India's organ donation law works, and why it is designed the way it is.

THOTA: the law behind organ donation in India

Organ donation in India is governed by the Transplantation of Human Organs and Tissues Act (THOTA), 1994, together with its 2011 amendment and the national rules issued in 2014. The law has three broad aims:

• to regulate how human organs and tissues are removed, stored and transplanted for treatment;
• to set the rules for both living and deceased donation; and
• to stop the buying and selling of human organs and tissues.

Who runs the system: NOTTO, ROTTOs and SOTTOs

At the national level, the National Organ and Tissue Transplant Organisation (NOTTO), which sits under the Directorate General of Health Services, runs the National Organ Transplant Programme. It maintains the national registry of donors and recipients, sets protocols and oversees fair distribution of organs.

Below it, Regional (ROTTO) and State (SOTTO) Organ and Tissue Transplant Organisations coordinate organ procurement, waiting lists and awareness in their regions, creating a three-tier network across the country.

Who can donate an organ?

THOTA allows organs and tissues to be transplanted from living donors, and from people who have died, either after brain stem death or after the heart has stopped. Living donors fall into two groups:

• Near relatives: spouse, children, grandchildren, siblings, parents and grandparents. Their donation is approved by the hospital's Competent Authority: the head of the hospital doing the transplant, or a committee they set up whose members are not part of the transplant team.
• Unrelated donors: anyone else. Their donation, and any case involving a foreign national, needs clearance from an Authorisation Committee. This is based at the hospital if it performs 25 or more transplants a year, and otherwise at district or state level.

Our guide explains living donation and brain stem death in more detail.

Can you donate an organ to a stranger?

Yes. An altruistic donation is one made without payment or any other prohibited benefit. Section 9(3) of THOTA allows a living person to donate to someone who is not a near relative out of "affection or attachment" or for other special reasons, provided there is no commercial transaction.

Because this route could be misused to hide organ sales, it is closely checked:

• The Authorisation Committee examines whether the decision is entirely voluntary and free of any financial motive.
• Under the 2014 Rules, the donor and recipient must state why the donation is being made and confirm it was not the result of pressure, inducement, influence or allurement.
• Using false documents or affidavits to present a paid arrangement as a relative's donation, or as one made out of affection, is a criminal offence.

The courts have backed genuine donors. High Courts, including those in Kerala and Karnataka, have held that sincere altruistic and anonymous donations to strangers are lawful and cannot be rejected on vague suspicion. Kerala already has formal guidelines for these cases, and Karnataka is now putting a structured process in place. Implementation still varies from state to state.

Penalties for organ trading

Section 19 of THOTA bans every part of commercial organ dealing: paying or being paid for an organ, looking for someone to sell an organ, offering an organ for payment, arranging or negotiating such deals, running an organisation involved in them, advertising them, and preparing false documents to disguise them.

• Removing an organ without authorisation: up to 10 years in prison and a fine of up to ₹20 lakh.
• Commercial dealing in organs: 5 to 10 years in prison and a fine of ₹20 lakh to ₹1 crore.

Read more about how the law protects donors in our section on law and ethics.

What international guidelines say

Internationally, the World Health Organization's Guiding Principles on Human Cell, Tissue and Organ Transplantation, endorsed by the World Health Assembly, set the main standards for donation from both living and deceased donors. They call for donation to be voluntary and unpaid, based on informed consent, protective of donors, and fair in how organs are allocated. The WHO recognises altruistic donation as an important principle, but leaves the detailed rules to each country's own laws.

What this means for you

India's law is built so that giving an organ is always a free and informed choice, never a transaction. If you would like to help, the simplest step is to pledge to donate your organs after death. It is free, takes only a few minutes, and you can change your mind at any time. Our step-by-step pledging guide explains how, and why it is important to talk to your family about your decision.

Source: Vrinda Goel, "Organ donation in India: How the system works and what law says", Business Standard, 1 October 2026.