Modern transplantation dates to 1954, when Ronald Lee Herrick donated a kidney to his identical twin Richard Herrick in an operation led by Dr Joseph Murray. Because the twins were genetically identical, the graft was not rejected - the discovery that opened the field. Murray shared the 1990 Nobel Prize in Physiology or Medicine with E. Donnall Thomas for discoveries concerning organ and cell transplantation in the treatment of human disease. India's own turning point came in 1994, the same year THOTA was enacted, when the country's first successful deceased-donor heart transplant was performed; it is that anniversary which prompted the shift of Indian Organ Donation Day from 27 November, observed since 2010, to 3 August from 2023. Donation itself takes three forms. Living donation covers one kidney, part of the liver and in selected cases part of the lung, pancreas or intestine. Deceased donation follows a declaration of brain-stem death under the prescribed legal procedure and can yield the heart, lungs, liver, kidneys, pancreas and intestine, with hands and face in special cases. Tissue donation - corneas, skin, bone, tendons and heart valves - remains possible even where organ donation is not.

India's transplant numbers look impressive and its donation rate does not, and both statements are true at once. The 20,138 transplants of 2025 make India third in the world by volume, but the great majority come from living donors - deceased-donor transplants were only 3,526 of that total. Since a deceased donor can serve up to eight recipients while a living donor can give one kidney or part of a liver, the deceased donation rate is the number that actually decides how many people on a waiting list ever get called. At under one donor per million population against Spain's roughly 48, India's constraint is not surgical capacity but consent, awareness and the speed with which brain-stem death is identified and families are approached. That is precisely what an awareness day is for, and it is why the exam-relevant content sits in the institutional layer - THOTA 1994, the 2011 amendment, and the NOTTO-ROTTO-SOTTO chain - rather than in the observance itself.