Evolving Frameworks: A Narrative Review of National and Global Policies on Organ Donation and Transplantation

Organ donation is a life-saving intervention; however, a global shortage of organs persists due to various medical, legal, ethical, and social factors. Policies governing organ donation play a pivotal role in shaping public attitudes, regulating practices, and improving donation rates. A narrative review approach was used to analyse national and international policies, acts, and regulatory frameworks related to organ donation. Sources included government documents, published literature, and reports from transplant organisations. Presumed consent policies, national registries, and centralised allocation systems have led to higher donation rates in several developed countries. In contrast, countries with opt-in systems often face challenges related to public awareness, infrastructure, and legal enforcement. India’s Transplantation of Human Organs Act (1994) laid the groundwork for legal organ transplantation; however, ongoing challenges include low deceased donation rates and the persistence of illegal organ trade. Effective organ donation policies require a balance of legal regulation, ethical safeguards, public engagement, and medical infrastructure. Strengthening policy implementation, promoting deceased donation, and ensuring transparency are essential steps toward improving organ donation systems globally and within India. The present review aimed to examine organ donation policies across different countries, with a focus on their structure, effectiveness, and implementation. It also highlights the evolution and impact of policies in the Indian context.