4 out of 5 live organ donors are women. Why?

CHENNAI: In 2023, a study by MOHAN Foundation, an NGO that’s a pioneer in promoting and facilitating organ donation in the country, revealed that 80% of live organ donors in India are women, while they constitute only 18.9% of organ recipients.

The report was based on another study published in the Experimental and Clinical Transplantation Journal in 2021, which stated that from 1995-2021, over 36,600 transplantations were carried out in the country, of which over 29,000 were for men and 6,945 were for women. It also revealed that 80% of the donors were women, mainly the spouse or the recipient.

It’s a known fact that more women volunteer to donate organs for their family members. While social conditioning is one of the causes responsible for it, women’s overall health and well-being are also other factors.

Liver diseases

With alcohol consumption being more common among men than women, the former is more at risk for liver diseases.

“The most common cause for liver diseases is fatty liver, alcohol induced liver cirrhosis and viral hepatitis. And these are more common in men than women,” says Dr Vivekanandan Shanmugam, lead surgeon, Liver Transplantation at SIMS Hospital.

The way he explains it, the age group of patients who require a transplant is mostly between 40-60 years of age, which implies that it’s due to 10-15 years of consumption. In this age group, the patients’ children are too young to donate, and parents are too old. So, the responsibility falls squarely on the spouse to donate for her spouse.

“Whenever we have to choose between a male or a female donor, we look at the quality and quantity of the donor-liver. The quality of the liver is, often, better in women than men. The incidence of Viral Hepatitis is also more common among men than women; so more women become donors, but this too could change over time as alcohol consumption is also increasing among women,” he added.

Patriarchal beliefs

Jayalakshmi, who is in her 30s, didn’t hesitate for a second before donating her liver for her husband. Her sister-in-law was also willing to donate for her brother but her profile did not match.

Family issues such as financial stability is also an important factor, another reason why many men in the family do not donate.

However, doctors cite social factors as the main reason for more women donors volunteering to donate. Dr Joy Varghese, director of hepatology & transplant hepatology, Gleneagles Global Health City, says that for a man at the end stage of liver disease, it’s always his wife who offers to donate her organ. “Families do not allow the son to donate since he is expected to be the primary breadwinner if he’s married or gets married later on. If the patient is a woman, her husband almost never volunteers to donate due to age factors and other illnesses. Quite often, it would be one of her family members who donate,” points out Dr Joy.

In cases of paediatric liver transplant, mothers or other women in the family donate the organ, as the men are often the primary breadwinners of the family.

“Also, those treated under the Chief Minister’s Comprehensive Health Insurance Scheme are from a lower socioeconomic background, where men are the primary breadwinners, and usually daily-wage labourers. After the surgery, a donor needs to rest for up to three months which is not possible for a primary breadwinner. So, the mother or other women volunteer to donate their organs,” he adds.

Emotions, marital status

Lack of financial independence, poor literacy rate and very little body autonomy among women make them more susceptible to coercion by family members to donate.

Also, social conditioning expects women to be more giving, and sacrifice their health and welfare for the sake of their husband and his family. This makes them more ‘willing’ to donate their organs for their spouse.

Additionally, many advancements in the field of organ transplantation have reduced fatalities and complications during transplant surgeries, especially for the donor. However, lack of awareness about it, and skewered gender roles in the Indian society, have made it easy for families to convince their women to be donors.

Senior consultant and associate director of the Institute of Liver Transplant & HPB Surgery, MGM Healthcare, Dr Karthik Mathivanan, explains: “Emotional quotient is higher in women than men, which makes them more willing to donate than men. There was a patient with liver damage due to prolonged alcohol consumption, and the wife donated her liver but he started drinking again and ultimately died.”

On the other hand, unmarried young women, and married women with no children, are discouraged from donating by their parents and immediate family.

Kaviya’s father was an alcoholic, which damaged his liver. Though her lipid profile matched his, the immediate family discouraged her from donating due to her unmarried status. They believed she might develop health complications in the future.

Since there was no other individual in her family who could donate, Kaviya underwent counselling and was assured that she would be able to function normally. After that, she donated her liver.

She admits that the onus of being a primary breadwinner was on the male members of the family in most cases. “I am just 22 and since I am not earning, the family finances would not be affected. My elder brother also volunteered to donate but his profile didn’t match. If it had, it would have been difficult for the family to manage expenses, as he’d have to rest for many months,” stated Kaviya.