Introduction:
In a significant intervention addressing systemic gaps in public healthcare infrastructure, the Andhra Pradesh High Court has called upon the State government to place on record a clear and comprehensive draft policy outlining its proposed expansion of organ transplant facilities. The direction came in the course of hearing a long-pending Public Interest Litigation titled President, Gareeb Guide (Voluntary Organization), Hyderabad v. State of Andhra Pradesh and Others (WP (PIL) No. 93 of 2016), which raises concerns over the inadequate availability of medical centres equipped to conduct organ transplants.
The PIL, filed nearly a decade ago, reflects a persistent issue in India’s healthcare system—the limited accessibility and uneven distribution of specialized medical services such as organ transplantation. Given the life-saving nature of such procedures, the lack of adequate infrastructure, trained personnel, and institutional capacity has been a matter of serious concern, particularly for economically weaker sections who rely on public healthcare.
The case gained renewed attention when the High Court, by an earlier order dated 10 December 2025, directed the Principal Secretary of the Department of Health, Medical and Family Welfare to submit a detailed affidavit. The Court sought specific data regarding hospitals in the State that possessed the requisite infrastructure and qualified medical professionals necessary for performing organ transplants. The purpose was to identify potential facilities that could be designated as Organ Transplant Centres (OTCs), thereby expanding access to such critical services.
In response, the State filed an affidavit outlining its position. It expressed reservations about the feasibility of establishing transplant facilities in all hospitals with 100 beds, citing financial constraints and the potential strain on public resources. The State maintained that it already had an adequate number of transplant centres in both the public and private sectors. At the same time, it indicated that it was considering a phased policy approach to improve deceased donor organ transplantation, with implementation envisaged by the year 2030.
However, the Division Bench comprising Chief Justice Dhiraj Singh Thakur and Justice Challa Gunaranjan found the affidavit lacking in specificity. Observing that the policy contours were vague and general in nature, the Court directed the State to submit a clear draft policy for judicial scrutiny before the next date of hearing.
Arguments of the Parties:
The petitioner, a voluntary organization working under the name Gareeb Guide, approached the Court with the objective of addressing what it perceived as a critical shortfall in the State’s healthcare infrastructure. The petitioner argued that access to organ transplantation is not merely a matter of medical advancement but a fundamental aspect of the right to life under Article 21 of the Constitution of India. It was contended that the State has a constitutional obligation to ensure that life-saving medical facilities are reasonably accessible to all citizens, irrespective of their economic status.
The petitioner emphasized that the existing number of organ transplant centres was grossly inadequate when viewed against the population size and the growing demand for such procedures. It pointed out that many patients, particularly those from rural or economically disadvantaged backgrounds, are forced to travel long distances or rely on expensive private hospitals, thereby creating inequities in access to healthcare.
Further, the petitioner highlighted the lack of a structured and transparent policy framework governing the expansion of organ transplant facilities. It argued that without a clear roadmap, the State’s efforts would remain fragmented and insufficient to meet the needs of the population. The petitioner sought a comprehensive policy that would not only identify potential hospitals for upgradation but also address issues such as training of medical personnel, infrastructure development, and promotion of organ donation.
On the other hand, the State of Andhra Pradesh defended its position by pointing to practical constraints and resource limitations. In its affidavit, the State argued that establishing organ transplant facilities in all 100-bedded hospitals was neither feasible nor economically viable. It submitted that such an approach would impose an unsustainable burden on the public exchequer and could divert resources from other essential healthcare services, thereby affecting overall healthcare delivery.
The State further contended that it already possessed an adequate number of organ transplant centres, both in government hospitals and in the private sector, to cater to existing needs. It maintained that the focus should be on optimizing the functioning of these centres rather than indiscriminately expanding infrastructure.
At the same time, the State acknowledged the need for improvement and informed the Court that it was in the process of formulating a policy for phased expansion of organ transplant facilities. According to the affidavit, the proposed plan would be implemented in two phases. Phase I would focus on strengthening existing tertiary care and teaching hospitals that already possess some level of infrastructure, while Phase II would involve gradual expansion and capacity building to extend services to additional centres.
However, the petitioner expressed dissatisfaction with the State’s response, arguing that the proposed plan lacked clarity, timelines, and measurable objectives. It was submitted that merely stating an intention to formulate a policy by 2030, without providing concrete details, did not address the urgency of the issue. The petitioner urged the Court to ensure that the State adopts a more structured and accountable approach.
Court’s Judgment:
The Andhra Pradesh High Court, in its interim order, adopted a balanced yet firm approach, recognizing both the importance of the issue and the limitations faced by the State. The Court did not outright reject the State’s position regarding financial constraints but emphasized that any policy concerning public health, particularly one involving life-saving procedures like organ transplantation, must be clearly articulated and capable of judicial scrutiny.
The bench noted that the affidavit submitted by the Principal Secretary contained only broad and general statements, particularly in relation to the proposed policy outlined in paragraph 10. The Court observed that while the State had indicated its intention to implement a phased plan, it had failed to provide sufficient details regarding the scope, structure, and implementation strategy of the policy.
In its observation, the Court remarked that the averments made by the State were “quite general in character” and did not adequately convey the precise contours of the proposed policy. This lack of specificity, the Court noted, made it difficult to assess whether the State’s approach was reasonable, effective, and aligned with its constitutional obligations.
The Court’s insistence on a detailed draft policy reflects a broader principle in administrative law—that governmental decisions, especially those affecting fundamental rights, must be transparent, reasoned, and based on clearly defined criteria. By directing the State to place the draft policy on record, the Court sought to ensure that the policy would be subjected to judicial review and public accountability.
At the same time, the Court’s approach demonstrates judicial restraint. Rather than dictating the specifics of the policy or imposing immediate directives for expansion, the Court allowed the State the opportunity to formulate its own framework. This reflects an understanding of the separation of powers, where policy-making is primarily the domain of the executive, while the judiciary’s role is to ensure that such policies are constitutionally compliant.
The invocation of the right to health as part of the right to life under Article 21, though not explicitly elaborated in the order, forms the underlying constitutional backdrop of the case. Over the years, Indian courts have consistently held that access to adequate healthcare is an integral component of the right to life. In this context, the availability of organ transplant facilities assumes particular significance, given their potential to save lives.
The Court’s direction to submit a draft policy by a specified date, namely 22 July 2026, underscores the urgency of the matter. It also signals the Court’s intention to engage in a more detailed examination of the State’s approach in subsequent hearings.
In conclusion, the High Court’s order represents an important step towards ensuring greater accountability and transparency in public healthcare policy. By insisting on a clear and detailed roadmap, the Court has laid the groundwork for a more structured and effective approach to expanding organ transplant facilities in the State. The outcome of the case will likely have broader implications, not only for Andhra Pradesh but also for other states grappling with similar challenges in healthcare infrastructure.