1. The present Writ Petition has been filed at the instance of the Indian Society of Organ Transplantation in order to highlight the issues with regard to uniformity, equality and access in the realm of organ donation for both the donors and the recipients.

2. The Transplantation of Human Organs Act, 1994 (for short, "the 1994 Act") was enacted pursuant to the resolutions passed by various States under Art.252(1) of the Constitution of India. The said legislation falls under Entry 6 of List II of the 7th Schedule pertaining to "Public health and sanitation; hospitals and dispensaries". The 1994 Act was adopted by all the States.

3. Certain important amendments were made to the 1994 Act in the year 2011, again pursuant to the resolutions passed by the States under Art.252(1) of the Constitution of India. The main purpose of the 2011 amendment was to include 'tissue' transplants within the scope of 1994 Act. The said amendment also introduced S.9(3A) enabling swap transplantation for the first time. It also broadened the definition of 'near relatives', set up the National Human Organs and Tissues Removal and Storage Network, and established the National Registry for Transplants. The Transplantation of Human Organs and Tissue Rules, 2014 (for short, "the 2014 Rules") were also brought into force in line with the changes made in the 1994 Act.

4. It appears that one of the States, i.e, the State of Andhra Pradesh has not yet adopted the 2011 amendment. It further appears that the States of Karnataka, Telangana, Andhra Pradesh and Manipur have not yet adopted the 2014 Rules. It further appears that after the last affidavit was filed by the Union of India, as per the directions issued by this Court, now the State of Karnataka has passed a resolution dated 21.08.2025 adopting the 2011 amendment. Such a non adoption till now, severely impedes the possibility of adoption of a uniform national policy and national grid and reduces the chances of transplantation in the concerned States as well as the rest of the country.

5. We, therefore, request all the States / Union Territories, who have not yet adopted the 2011 amendment and / or the 2014 Rules, to take into consideration the importance of the issue and adopt the same.

6. It further appears that two north - eastern States i.e, Meghalaya and Nagaland and three Union Territories, i.e., Andaman and Nicobar Islands, Lakshadweep and Ladakh are presently functioning without a State Organ and Tissue Transplant Organization (for short, "SOTTO"). Mr. K. Parameshwar learned senior counsel appearing on behalf of the petitioner submits that unless the SOTTO is established in the said States / Union Territories, the work of organ / tissue transplant cannot be performed.

7. Learned senior counsel for the petitioner further states that there is an acute shortage in the number of organ donations in the country. He submits that in order to tackle the shortage, two policy measures need to be taken. First is linking of brain - stem death certification with the death certification, and the consequent option to donate organs. The second suggestion of the learned senior counsel is development of a national policy as well as national portal to operationalize swap transplantation under S.9(3A) of the 1994 Act.

8. Insofar as brain - stem death certification is concerned, learned senior counsel submits that Form 4 and Form 4A of Registration of Births and Deaths Rules, 1999 be amended across the country to include a column on brain dead certification and an option to donate organs. It is the contention of the petitioner, which is working on the national level in the field of organ transplantation, that such a measure would exponentially increase awareness of possibility of the organ donation in brain dead persons and will increase the number of organ donations pursuant thereto.

9. The learned senior counsel for the petitioner has highlighted that as per the National Organ and Tissue Transplant Organization (for