The Kerala High Court has directed the state government to implement a set of organ transplant reforms, including a kidney-swap programme and a digital platform for altruistic live donation, after a petition raised concerns over the commercialisation of organ donation in Kerala.
A division bench comprising Chief Justice Soumen Sen and Justice V M Syam Kumar issued the order on a petition filed by a 20-year-old from Thrissur. The petitioner’s father died of kidney disease at the age of 46 after struggling for four years to secure a transplant.
The court directed the state to implement recommendations made by an advisory committee constituted in 2024. The committee submitted its report to the government after a meeting on November 19, 2025, proposing measures intended to promote altruistic organ donation and improve transparency in the transplant approval system.
One of the key recommendations is the creation of a digital platform by the Kerala State Organ and Tissue Transplant Organisation, or K-SOTTO, in consultation with the National Organ and Tissue Transplant Organisation. The platform is intended to facilitate non-directed altruistic donations of organs and tissues, including kidneys, portions of the liver and skin, for patients in need.
The committee recommended that K-SOTTO alone invite applications for such donations, with strict confidentiality and anonymity safeguards. Under the proposed arrangement, K-SOTTO would initially bear the cost of evaluating donors. The recipient could reimburse those expenses after a successful transplant.
The court also directed the state to introduce a kidney-swap programme. Under such a system, two or more families with medically incompatible living donors can exchange donors so that each recipient receives an organ compatible with their blood group or tissue type. The bench directed that the programme must comply strictly with Section 9(3A) of the Transplantation of Human Organs and Tissues Act.
The recommendations also call for a platform to assess the number of patients with end-stage kidney, liver and heart diseases. K-SOTTO is expected to develop the system to support the formulation of long-term policies for organ transplantation in the state.
The advisory committee proposed additional administrative changes, including a revamp of the police inquiry into reports of illegal organ transplantation in Thrissur district. It also recommended that transplant centres disclose their charges transparently, publish upper limits for those charges and introduce a single-window, time-bound system for transplant approvals.
The reforms place K-SOTTO at the centre of the proposed system, combining donor applications, confidentiality safeguards, patient data and transplant approvals within a more structured institutional framework. The court’s directions also connect the state’s transplant administration to the wider legal safeguards governing organ donation.
Citing directions issued by the Supreme Court in Indian Society of Organ Transplantation v. Union of India, the bench said it was now the responsibility of the state government to accept and implement the advisory committee’s recommendations. The next stage is therefore the formal introduction of the kidney-swap programme and the related digital and administrative systems by the state and K-SOTTO.
