Rajasthan’s Ayushman Yojana Expands Transplants, But Gender and Rural Gaps Persist

The WHO-led review of Rajasthan’s Mukhyamantri Ayushman Arogya Yojana finds the scheme has made organ transplants more accessible and affordable for vulnerable groups, with high patient satisfaction. Yet, stark gender gaps, rural exclusion, and heavy out-of-pocket costs for complex surgeries highlight the need for reforms.

The World Health Organization (WHO) Country Office for India, together with the Government of Rajasthan and the Rajasthan State Health Assurance Agency, has carried out a landmark study on organ transplant packages under the Mukhyamantri Ayushman Arogya Yojana (MAA). The review, prepared by researchers Dr. Grace Achungura, Dr. Priyanka Pandit, and Mr. Jaidev Anand, offers the first comprehensive analysis of how this bold initiative has reshaped access to high-cost transplants in the state. It paints a picture of both remarkable progress and continuing inequities, highlighting Rajasthan’s role as a frontrunner in India’s journey towards equitable health coverage for complex medical procedures.

Transplants Made Affordable but Not Equal

Organ transplantation has transformed modern medicine, yet globally, only 10 percent of demand is met due to the scarcity of organs and prohibitive costs. India performs around 17,000–18,000 transplants each year, ranking third after the US and China, but affordability has always been a barrier. Against this backdrop, Rajasthan launched MAA Yojana in May 2021, covering 14.2 million families with risk protection of up to ₹25 lakh annually. In 2022–23, the government went further by including 37 transplant packages, ranging from kidney and liver to lung, heart, bone marrow, and cochlear implants. Beneficiaries even gained portability benefits, with airfare reimbursement for treatment outside the state.

From April 2022 to July 2024, 1,332 transplants were carried out under the scheme at a cost of ₹61.47 crore. Kidney procedures dominated, accounting for two-thirds of all surgeries, followed by cochlear implants and bone marrow transplants. Heart, lung, and liver operations were rare but significant in cost and complexity. Private hospitals handled 60 percent of the caseload, continuing their dominance in the transplant sector. Urban residents benefited most, with nearly two-thirds of recipients from cities, while only 36.5 percent came from rural areas, despite three-fourths of Rajasthan’s population living outside urban centers.

A Stark Gender Divide Emerges

One of the most striking findings was the glaring gender disparity. Men constituted 77 percent of transplant recipients, while women made up only 23 percent, even though disease prevalence between the sexes is similar. This mirrors a national paradox where women are far more likely to donate organs but much less likely to receive them. Cultural norms, economic dependence, and subtle biases in clinical decision-making appear to shape this imbalance. Age distribution revealed another bias: the majority of recipients were between 20 and 40 years old, followed by children and adolescents. Older patients had significantly lower access, suggesting a perception that their outcomes are less favorable, even though there is no legal age restriction.

Out-of-state treatment also highlighted inequities. Forty-six patients traveled mainly to Gujarat and Delhi for advanced transplants, underscoring the limited capacity of Rajasthan’s facilities. While the portability feature allowed them to access care, beneficiaries described reimbursement processes as slow and bureaucratic, often adding financial stress during recovery.

Patients Praise Quality but Struggle with Costs

The review placed strong emphasis on patient experiences. In interviews with 40 beneficiaries, satisfaction levels were overwhelmingly positive. Ninety-five percent rated services as excellent or good, citing pre-transplant consultations, communication with doctors, and follow-up care as exemplary. Three-fourths said accessing benefits was very easy, thanks to streamlined cashless mechanisms.

Yet beneath this success story lies financial strain. Fifty-five percent of beneficiaries reported out-of-pocket spending in addition to state coverage, usually between ₹1–5 lakh, but in some cases skyrocketing to ₹15–20 lakh, particularly for liver and lung transplants. These additional costs were tied to expensive medicines, diagnostics, or extended hospital stays due to complications. Patients treated within Rajasthan were far less likely to face these costs, while those seeking care outside the state bore the heaviest burdens. Some also reported delays in card activation, missing paperwork at health offices, and inconsistent communication from doctors. Nevertheless, most acknowledged that without the scheme, transplantation would have been entirely out of reach.

Building a Fairer and Stronger System

The study concludes that Rajasthan’s MAA Yojana has indeed succeeded in democratizing access to organ transplantation, but the job is far from done. Recommendations are pointed and practical: raise package rates for high-cost surgeries like liver, lung, and bone marrow transplants; create a top-up fund to cover catastrophic expenditures and lifelong immunosuppressant medicines; streamline reimbursement timelines, especially for out-of-state cases; and simplify bureaucratic hurdles such as no-objection certificates. Expanding the network of empaneled hospitals and launching targeted awareness campaigns in rural areas and among women were also strongly advised.

Importantly, researchers and patients alike urged a cultural shift, challenging gendered attitudes that prevent women from accessing transplants, while promoting success stories to break down stigma. With greater outreach, equitable distribution, and more transparent processes, Rajasthan can not only sustain but also expand the impact of this bold experiment.

The review ultimately portrays a health system in transition. Rajasthan has proven that state-led insurance models can bring expensive, high-technology medical care to the poor, changing the narrative from despair to hope for thousands of families. But it has also exposed the social, financial, and systemic barriers that remain. If these are addressed, MAA Yojana could become a national template for bridging the gap between medical innovation and social equity. For now, it stands as both an achievement and a call to action, a reminder that universal health coverage in India must go beyond primary care and embrace the complexities of modern medicine with compassion and fairness.