In 2018, I underwent a heart transplant in a city far from home. The medical procedure was lifesaving, but since then I have experienced a costly and frustrating struggle to access vital diagnostics, ICU care and essential immunosuppressants.

Since 2024, I have had a senior citizen health card under Ayushman Bharat, India’s flagship health insurance scheme. But I have never been able to use it at any part of my transplant journey. In theory, I am covered. In practice, I am uninsured.

My experience mirrors that of other organ recipients. India’s organ transplant programme exists on paper, but on the ground it is a patchwork of vague policies and inaccessible services.

The National Organ and Tissue Transplant Organisation, India’s nodal agency for transplants, has no financial or executive authority to take any action. Meanwhile, the country’s transplant system is fragmented with inadequate government support.

The gap between policy and delivery leaves recipients stranded their most vulnerable while recovering from complicated medical procedures.

Ayushman Bharat, which is touted as the world’s largest health insurance programme, aims to make tertiary care affordable for marginalised families. Heart and liver transplants were recommended for inclusion in the national scheme, but no formal announcement has followed.

Even when hospitals are empanelled under the scheme, they are under-resourced or...

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