Section 9(3A) of THOTA permits multi-party swap organ transplantations beyond two donor-recipient pairs.

The petitioners (consisting of four donor-recipient pairs) sought permission for a "four-way-swap kidney transplantation"

In each pair, the donor and recipient are "near-relatives" as defined under Section 2(i) of the Transplantation of Human Organs & Tissues Act, 1994 ("Act"), but are biologically incompatible

The Authorization Committee and the Appellate Authority rejected the proposal on the singular ground that Section 9(3A) of the Act only permits swap transplants between two incompatible pairs and does not provide for multi-way swaps involving more than two pairs

The petitioners challenged this restrictive interpretation before the High Court

Whether the Authorization Committee can permit, under Section 9(3A) of the Act, swap transplantations between multiple (more than two) donor-recipient pairs

The court primarily interpreted Section 9(3A) of the Transplantation of Human Organs & Tissues Act, 1994, which outlines the procedure for swap donations between incompatible near-relative pairs

Kuldeep Singh v. State of Tamil Nadu [(2005) 11 SCC 122], establishing that the Act’s object is to prevent commercial dealings rather than prohibit legitimate transplants

Indian Society of Organ Transplantation v. Union of India [2025 INSC 1361], which directed the evolution of national swap transplantation guidelines

GP Singh’s Principles of Statutory Interpretation that courts should adopt a reasonable and sensible construction that avoids anomalies or absurdities

The court reasoned that Section 9(3A) is a remedial provision intended to assist donor-recipient pairs who face biological incompatibility

It held that the statutory use of terms like "first donor" and "second donor" is illustrative of the procedure rather than a limitation on the number of participating pairs; interpreting it otherwise would border on "absurdity"

The court observed that as long as the core objective of the Act—preventing commercialization and organ trafficking—is satisfied, technicalities should not impede the saving of human lives

The court noted that other states (Karnataka and Kerala) and institutions (IKDRC, Gujarat) have already recognized and facilitated multi-way swaps, proving the scientific and ethical validity of the practice

Therefore, the purpose of the Act is furthered by an interpretation that expands the pool of compatible matches for sensitised patients

It held that Section 9(3A) does not bar inter-se transplantation between more than two pairs

The court directed the Authorization Committee to examine the feasibility of the proposed four-way swap transplant, ensuring all other legal requirements regarding the absence of commercial dealings are met