Transplanted lives: Organ donation in Kerala gains traction

Turning 18 can mean different things for different people.

For P. P. Devananda, a Plus Two student from Thrissur, it meant being old enough to donate her liver to P.G. Pratheesh, her father, who was battling liver cirrhosis and in urgent need of a transplant. But time wasn’t in her favour and she couldn’t wait until she turned 18, as her father’s condition was worsening. The family’s attempt to get the organ from one of their relatives failed as the proposed donor backed out citing some personal reasons.

It was around this time that Devananda began to pursue the idea of donating her liver? “Initially, everyone was opposed to the idea. They said it could cause severe pain. But I was determined to do it to save my father as time was running out for him,” she remembers.

She moved the Kerala High Court seeking permission for donating the organ as law forbids minors from donating organs. Eventually, she secured a favourable order from the court. And on February 9, 2023, two months before she turned 18, Devananda donated her liver to her father, thus becoming probably the first minor to do so. Now 21, Devananda says she just did what any daughter would do.

“We had to save him somehow. The surgery had to be carried out immediately and there was no time,” recalls Devananda.

Pratheesh says that the family always dissuaded her. “I never knew that she went to the court to get the order. She kept all those from me. I had told her not to think about donating; she was too young,” says Pratheesh.

The Class 12 student had to convince the system — the court, medical board, and clear a psychiatric evaluation. She also had to build up emotional strength to fight the naysayers, too. “My father’s case was one of the non-alcoholic liver diseases. People just assumed it was caused by alcohol intake and questioned my donation. It was really bad, life-changing. But now we are strong enough to face anything,” says Devananda.

Pratheesh considers himself extremely lucky to receive the organ at the right time. Yet, over 3,000 patients are waiting for donors as the life-saving practice of organ donation continues to be fraught with controversies, misrepresentations and misinformation, which the medical community keeps trying to fight.

Till January 28, 2025, as many as 3,261 people are on the organ waiting list, with the majority in need for kidney (2,450), followed by liver (659), heart (85) and other organs.

The tale of two brothers

In 2014, Akshay Manoj, a resident of Marampally, Aluva, in Ernakulam, was just 13 when he underwent dialysis. A major part of his growing-up years was spent in hospitals. He was suffering from kidney failure following a genetic disease.

“Three visits per week,” recalls Akshay about his earlier life. “At first, I thought the transplant would happen without much delay. Then some ten years passed; I lost hope and got used to it,” says Akshay.

And then several years later, his elder brother, Anandhu Manoj, also had to be put on dialysis, as he fell victim to the same disease. “I used to accompany Akshay earlier for dialysis. Then I had to undergo the treatment,” says Anandhu.

P. P. Devananda along with her father P.G. Pratheesh. Devananda had donated her liver to her father when she was just 17, saving his life and probably becoming the first minor to do so.
| Photo Credit:
K.K. Najeeb

It wasn’t something the family was prepared for; they waited for a donor. And then in 2024, Anandhu received a deceased donor transplant. “I don’t know the family who donated the kidney. I asked, but they didn’t want to reveal the identity of the donor,” says the 26-year-old. Eventually in 2025, after waiting for more than ten years, Akshay too received a kidney from deceased donor Biljith Biju.

Eight organs were harvested from the youngster who was declared brain-dead following a road accident in Kochi and Akshay was one of the beneficiaries. Incidentally, the donation came less than 24 hours after six organs were harvested from a 28-year-old brain-dead Isaac George, a restaurateur in Kottarakara in Kollam district, who was hospitalised following a road accident.

The two back-to-back cases of organ donations went viral and ignited a wave of organ pledging in the State. The next few days witnessed over 500 people pledging their organs. The year 2025 thus saw a renewed enthusiasm in deceased organ donation, with the donor numbers more than doubling compared to the previous year.

A total of 25 deceased donor donations have been recorded at the Kerala State Organ and Tissue Transplant Organisation (K-SOTTO) in 2025. The total number of deceased donor organs donated stood at 75, with kidney being the most donated organ (41), liver (21), and heart (seven), as per data from K-SOTTO.

The total number of organs donated in the past 13 years stands at 1,171, with a total donor number of 403. Over the years, deceased organ donation dipped, with just eight deceased donors in 2018. But a rise in awareness among the community contributed to the increase in the number of deceased organ donations, with families of brain-dead patients coming forward for organ donation, say medical experts.

Though many advancements have been made in the area of organ transplantation globally, it’s in its nascent stages in Kerala. It hasn’t been long since transplant as a treatment option for end-stage organ failure was considered, says Noble Gracious, Executive Director of K-SOTTO and State convener of the Mrithasanjeevani organ transplant programme.

“All challenges are within the hospital community, rather than societal. On the medical front we face the challenge of reluctance to certify brain stem death among patients. It has been observed that the organ donation process is often initiated by the donor family, rather than hospitals,” observes Dr. Gracious.

There are operational and logistical challenges too.

“There are more than 50 registered transplant centres in our State. Yet, not all of them can actively execute and implement organ transplantation. This is because cadaveric transplants are unplanned high-intensity activities and the scale of preparation is extensive,” he adds.

Life after transplant

After organ donation, life is never the same for the donor family nor for the recipient. A. Babu, father of Amal Babu, whose organs were donated last year, says that his son continues to live with six people even after his death.

For Jose Jacob, an Ernakulam native, who received a liver transplant from his son Rohit Jacob Jose, it was not an easy decision to take as his son was in the springtime of his life. “Initially, I was opposed to the idea considering his age and the risks the decision would bring upon him. However, Rohit stood his ground and forced me to accept his decision,” he says.

On his part, Rohit says he was convinced of the idea of being the donor for his father from the beginning. “I was sure that I was the best choice for him given my age and health conditions. I was not scared of the possible risks involved though doctors had warned me about it. I know it was the best decision that I took for my father,” says Rohit.

Jose, who is penning a memoir covering post-transplant days, jokingly adds that his relationship with his son has changed slightly after the procedure. “I often find myself not being able to scold him. He teases me, saying that he has given me everything he could in his lifetime,” he laughs.

Everyone who has had a transplant talks about having received a new lease of life, of priorities getting changed, families getting stronger as a unit, chasing life with a passion, and following healthier and intentional choices moving forward.

For T.R. Manu, a Thodupauzha native, life’s trajectory and career itself went through a sea of change. It was in 2013, at the age of 27 that Manu lost both his palms after being pushed off a moving train. “I just remember falling from the train; when I woke up and realised that I lost both my palms, my first thought was that my life had ended. I didn’t want to live any more,” recounts Manu.

While prosthetic limbs were an option, he wasn’t keen on that due to a host of reasons. “I hit on the idea of considering an arm transplant after being alerted by a cousin, who chanced upon a TV programme on organ transplant,” says Manu.

A hand transplant was something unheard of in India at that time. Yet, he decided to give it a go. “When you have no other choice, you start believing in doors that open. I had complete faith that it could work,” recalls Manu.

Then it happened. A family was ready for cadaver donation. The hand transplant took place in 2015, a first in the country. Life had kept more surprises for Manu at the hospital. There he met V.S. Sreeja, a nurse, who would later become his life partner.

“I saw him at the hospital and I felt like sharing my life with him. So I proposed,” Sreeja says, blushing. “At first he said no. He insisted that the doctor treating him should give permission. I persisted, and after a year, he said yes,” says Sreeja, as their kids play merrily around her.

Manu, who recaptured his life, is now a transplant counsellor at the hospital where he underwent the procedure. “Who better to talk about the transplant to the families than someone who has undergone it?” asks Manu.