Life After Transplant: Why India's Middle-Income Families Are Falling Through the Cracks

Patients who undergo organ transplant due to end-stage organ failure take immunosuppressant medicines on a daily basis, undergo regular diagnostic tests and remain under constant medical supervision. Their monthly medicine expenses are usually between Rs 15,000 and Rs 25,000, excluding frequent blood tests, biopsies, and consultations. Even a brief interruption in treatment can lead to organ rejection, undoing the success of surgery and wasting a scarce national resource donated by a grieving family.

In India, financial support through government schemes like Rashtriya Arogya Nidhi are largely limited to patients who fall in the below-poverty-line (BPL) category. It is generally assumed that anyone, not poor, is wealthy enough to pay independently. This assumption is both misleading and dangerous.

Also read: Why India Faces a Shortage of Cadaver Organ Donations

The assumption that only the poor need help is short-sighted. Organ transplantation is not like a cataract or a knee replacement surgery. It is a lifelong commitment with costs that even middle-income households cannot sustain without assistance – the salaried, the self-employed, the small business owners – for instance, cannot absorb an extra Rs 2-3 lakh annually for medicines and diagnostics, on top of housing, education, and retirement costs.

Middle-income families often sell assets, pledge gold, or take personal loans to keep the donor organ alive. Some fall into medical bankruptcy, slipping into poverty themselves. Yet their struggles are largely invisible in public policy debates because they do not fit neatly into “poor” or “rich” categories.

Maharashtra’s innovation and its limits

In  September 2025, Maharashtra chief minister Devendra Fadnavis announced that the state government will create a corpus fund to cover organ transplants and other treatments that cost more than Rs 5 lakh. He has approved the inclusion of 2,399 procedures under the unified Ayushman Bharat-PMJAY, Mahatma Jyotiba Phule Jan Arogya Yojana (MPJAY) insurance schemes for the less privileged. The schemes will cover heart, lung, kidney, and bone marrow transplants, ensuring financial support for patients. However, the middle class remains outside its ambit.

The dangerous paradox

A 39-year-old IT professional from Pune underwent a heart transplant. “The surgery saved me, but my EMI and my medicine bill compete every month. I tell my children their education will not suffer—  but inside, I fear we may have to sell our home one day just to keep me alive,” the patient says.

This paradox undermines the transplant programme as a whole.

When middle-income patients cannot afford post-transplant care, the consequences extend beyond individual families:

• Wasted donor organs: Missed doses or skipped tests can lead to organ failure, wasting not only medical effort but also the altruism of donor families.
• Medical bankruptcy: Already stretched thin, middle-class families fall into debt, eroding financial stability across generations.
• Discouraged organ donation: If potential donor families perceive that recipients cannot afford long-term care, their willingness to donate declines, further depressing India’s already low organ donation rate.

What can be done

In order to ease the burden, medicines critical to transplant survival should be exempt from Goods and Services Tax, which will decrease costs by 5%.

Moreover, a universal transplant reserve fund can be established at the national and state-level for all the transplant recipients, regardless of income to cover medicines and diagnostics. While the BPL families can be subsidised fully, middle-income families may be provided partial support to ease their burden, and wealthy patients can co-pay fully.

Both public and private health insurers in the country must include lifelong post-transplant care, not just the one-time surgery. The West has already recognised that actuaries’ risk calculations cannot override medical realities. 

Notably, India has made great strides in expanding access to transplantation, but the story cannot stop with surgery. A truly humane system will ensure that every donated organ is protected for the longest possible time. It requires supporting recipients not just during surgery but for the lifetime that follows.

Middle-income families don't need charity. They want the government to recognise their reality: lifelong medical bills of Rs two-three lakh per year are unsustainable even for salaried taxpayers. Since they already carry the financial and emotional trauma of end-stage organ failure, forcing them to stress over funding post-transplant care replaces one form of suffering with another. A well-conceived policy would protect precious donor organs, safeguard families from financial ruin, and reinforce public trust in India’s transplant programme.

Also read: Hope, Suffering and the Truth About Organ Transplants

Organ transplantation is one of medicine’s greatest gifts. Donor families give a part of their loved one so that another may live. The least society can do is ensure that these lives are not cut short for want of medicines.

By extending support beyond poverty lines, the government would send a powerful message that every life saved is equally valued, and no family should regret consenting to organ donation. Understandably, by broadening the transplant reserve fund and designing support systems that include – not exclude – the middle-income group, India can fulfil its moral responsibility to both donors and recipients.

Note: This article has been updated at 4.39 pm on October 29, 2025 to include a case study.

Viney Kirpal is a heart transplant (2018). She has highlighted the financial difficulties of organ recipients in New Life. New Beginnings: Compelling Stories by Organ Recipients, Donors, and Doctors (July 2025).

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