Rule 18 of the THOTA Rules, 2014, and the Limits of the Authorisation Committee’s Power in Near-Relative Live Donation Cases

1. Introduction

The Transplantation of Human Organs and Tissues Act, 1994 (as amended in 2011) and the Transplantation of Human Organs and Tissues Rules, 2014 (“THOTA Rules, 2014”) were designed to do two things at once: make legitimate, altruistic organ donation possible, and choke off commercial organ trade. The statute draws a sharp line between two categories of living donors — “near relatives” as defined in Section 2(i) of the Act (spouse, son, daughter, father, mother, brother, sister, grandfather, grandmother, grandson, granddaughter), and donors who are not near relatives, who may donate only “by reason of affection or attachment” under Section 9(3).

This distinction matters enormously for procedure. Section 9(1) permits near-relative donation without prior approval of the Authorisation Committee — the sanctioning authority for a near-relative case is the “competent authority” as defined in Rule 2(c), ordinarily the head of the transplanting hospital or a committee constituted by that head. It is only donation between persons who are not near relatives (and cases involving foreign nationals, or swap transplants) that Section 9(3), 9(3A) and 9(1A) route to the Authorisation Committee for full scrutiny of affection, attachment, absence of commercial dealing, and so on.

Where a case genuinely falls in the “near relative” category, the governing procedure is not the elaborate non-relative inquiry — it is Rule 18 of the THOTA Rules, 2014.

2. What Rule 18 Actually Says

Rule 18, titled “Procedure in case of near relatives,” lays down what the competent authority must look at where the proposed donor and recipient are related genetically (grandparent, parent, sibling, child) or by marriage (spouse). In substance, the rule requires the competent authority to evaluate:

• Tissue typing and other basic medical compatibility tests — to confirm the donor is medically fit and compatible, not to prove the relationship itself.
• Documentary evidence of relationship — birth certificates, marriage certificates, or a certificate from a Sub-Divisional Magistrate, Metropolitan Magistrate, or Sarpanch of the Panchayat.
• Documentary evidence of identity and residence — ration card, voter ID, passport, driving licence, PAN card, bank account details, and a family photograph showing the donor and recipient together with another near relative.
• Further medical/DNA tests, but only as a discretionary fallback — Rule 18 itself makes this conditional: such tests are to be directed only if, in the competent authority’s opinion, the relationship is not conclusively established after evaluating the documentary evidence above. Even then, the rule contemplates HLA/DNA testing of parents or other relatives, not as a default, universal requirement for every applicant.
• For a spousal case specifically — the competent authority must evaluate the factum and duration of the marriage through the marriage certificate and marriage photographs, together with information on the number and age of children, a family photograph of the immediate family, and the children’s birth certificates showing the parents’ particulars.
• Time-bound, reasoned decision-making — the rule (read with the related provisions on the Authorisation Committee’s functioning) requires the decision to be recorded in writing, with a clear rejection or approval, and generally within a defined time frame given the urgency of transplant cases.

What Rule 18 conspicuously does not require, as a blanket rule for every near-relative case, is: a DNA test irrespective of documentary proof; an affidavit or personal appearance/consent of every other family member; the consent of a donor’s or recipient’s spouse who is not himself or herself a party to the donation; or any open-ended, undefined “authenticity verification” obligation imposed on the hospital over and above what the rule already prescribes.

3. The Core Legal Principle: The Committee/Competent Authority Cannot Travel Beyond Rule 18

A recurring theme across recent High Court decisions is that once a case is a genuine near-relative case, the Authorisation Committee or competent authority’s role is confined to satisfying itself on the touchstones Rule 18 actually lists — it cannot invent additional criteria, presumptions, or documentary demands that the rule does not contain.

This was stated most directly by the Madras High Court in Atonu Saha v. State of Tamil Nadu (2026), where the Authorisation Committee had refused permission for a Bangladeshi mother to donate a kidney to her minor son, on the ground that the spousal relationship between the boy’s parents was doubtful. Justice G.R. Swaminathan held that the spousal relationship was “irrelevant” and that the Committee should have considered only whether the recipient was the son of the donor, so the Committee’s order was “vitiated by irrelevant consideration.”

The Court also expressly grounded the Committee’s task in the statute, observing that Rule 18 sets out the procedure to be adopted, under which the authority must satisfy itself about the genuineness of the documents actually produced, applying “a commonsense point of view” — and that if the documents establish the near relationship on that commonsense standard, an approval ought to be given. The Court added that the Committee’s job is not to hunt for reasons to reject a case but “to find out the truth.”

The same case is also useful on the standard of proof and on procedural fairness: the Court criticised the Committee for over-relying on oral answers given through an interpreter by Bengali-speaking applicants, holding that where oral testimony is at variance with the documentary evidence, it is the document that should be preferred, that the standard of proof in such cases cannot be placed at a high threshold — especially for applicants in urgent need of a transplant — and that the committee “must not nurture fanciful doubts or lingering suspicion.”

4. DNA Test as a Mandatory Requirement in All Cases — Illegal

Rule 18 treats a DNA or HLA-based genetic test as a last-resort, discretionary step, to be invoked only when documentary evidence fails to conclusively establish the relationship — not as a universal precondition. Courts have repeatedly struck down Committee practices that convert this into a blanket rule.

In Rita Chaurasiya v. State of Tamil Nadu (Madras High Court, 2026), the State Authorisation Committee had refused to approve a mother’s donation of her kidney to her son on the ground that the biological relationship was not conclusively established, and had, in substance, insisted on a DNA test. Setting aside that order, Justice Swaminathan held that where the donor claims that the recipient is none other than her own biological son, a refusal on that basis was unjustified. As reported, the Court went on to hold that the mother could not be compelled to undergo a DNA test to prove maternity, given that documentary evidence such as the birth certificate, Aadhaar card, and PAN card sufficiently established the relationship, applying the ordinary civil standard of the preponderance of probabilities. The Committee was directed to grant approval without insisting on genetic testing.

This is consistent with the structure of Rule 18 itself: DNA/HLA testing is listed as sub-clause (iv), triggered only “if in its opinion the relationship is not conclusively established” from the documents already listed in sub-clauses (i)–(iii). A standing practice of demanding DNA tests in every near-relative case — regardless of the strength of the documentary record — has no basis in the rule and has been judicially disapproved.

5. Demanding Affidavits and the Consent of Other Family Members — Illegal

Rule 18 does not require every family member of the donor or recipient to file an affidavit or personally consent to the donation. It requires proof of the donor-recipient relationship and (for spousal cases) proof of the marriage and immediate family. Making approval conditional on affidavits or personal buy-in from relatives who are not parties to the transaction goes beyond what the rule prescribes.

The clearest illustration is again Atonu Saha, where the Committee had effectively made the transplant contingent on establishing facts about the parents’ marriage rather than the only relationship that mattered — mother and son — and the Court held this to be an irrelevant consideration that vitiated the order.

Similarly, in the Prasanna Laxmikant Joshi case discussed below, the Committee had rejected a kidney-donation application specifically because a family member — the donor’s estranged wife and adult daughter — had declined to participate in the interview or give their consent. The Bombay High Court’s reasoning applies equally to any attempt to condition a near-relative donation on the affidavit or approval of relatives who are not themselves donor, recipient, or otherwise required by Rule 18.

6. Insisting on a Spouse’s Consent (e.g., Husband’s Consent for a Wife Donating to Her Own Parent) — Illegal

This is squarely settled by the Bombay High Court in Prasanna Laxmikant Joshi and Anr. v. State of Maharashtra and Ors. (2023). There, the Regional Authorisation Committee had declined to approve a kidney donation because the donor’s estranged wife and their daughter had not participated in the interview or given their consent.

Setting aside the refusal, the Division Bench (Patel and Gokhale, JJ.) held that authorities cannot insist on spousal consent for organ donation, and specifically that spouse’s consent is not a mandatory requirement for organ donation under the Act, especially where consent is withheld unreasonably or for extraneous reasons. The Court went further, observing that the Act makes no provision for a spouse withholding consent even unreasonably or for extraneous reasons.

Although Joshi involved a husband donating to his brother-in-law, its ratio is not confined to that fact pattern. Nothing in Rule 18 conditions a near-relative donor’s right to donate on the consent of that donor’s own spouse when the spouse is not the recipient and is not otherwise a party to the application. Requiring, for instance, a husband’s consent before his wife may donate an organ to her own parent (a near relative under Section 2(i)) has no footing in Rule 18 and is inconsistent with the donor’s personal autonomy and right to bodily integrity, which courts have located within Article 21 of the Constitution in this very line of cases.

7. Rejecting an Application Despite a Proper Birth Certificate and Family Documents — Illegal

Where the statutory list of documents under Rule 18(1)(ii)–(iii) — birth certificates, marriage certificates, identity and residence proof, family photographs — is placed on record and reasonably establishes the relationship, the competent authority is not entitled to reject the application by demanding something extra or by disbelieving adequate documentary proof without cogent reason.

This is illustrated by Rita Chaurasiya, where documentary proof (birth certificate, Aadhaar, PAN) was held sufficient and the Committee’s insistence on more (a DNA test) was set aside, and by Atonu Saha, where the Bangladeshi family had placed on record a passport, visa, notarised affidavit, an HLA/DNA report, the child’s birth registration certificate, school records and a national ID card, yet the Committee still refused permission on an issue (the parents’ inter se relationship) that was not even the relevant relationship under Rule 18. The Court found this approach legally misdirected and directed immediate approval, reiterating that the Committee’s task once adequate documents are on record is to apply commonsense and grant approval, not manufacture fresh grounds for suspicion.

8. “Any Other Proof, Document, Criterion or Presumption” Beyond Rule 18 — Illegal

Reading these decisions together, a consistent principle emerges: for genuine near-relative cases, the competent authority’s/Authorisation Committee’s inquiry is rule-bound, not open-ended. It must confine itself to the specific heads of evaluation Rule 18 sets out — medical compatibility, the documents Rule 18 itself lists, and (only where those documents leave real doubt) further medical/genetic testing. It cannot:

• Treat the list in Rule 18 as merely illustrative and add fresh categories of proof (extra affidavits, third-party consents, character or background criteria) that the rule does not mention;
• Apply an evidentiary presumption against the applicant (i.e., treat the relationship as unproven merely because documentation was not perfect, or because of language or communication difficulties during interview, as noted in Atonu Saha regarding interpreter-assisted testimony);
• Substitute its own subjective threshold of proof for the “commonsense,” reasonable-satisfaction standard Rule 18 contemplates; or
• Import considerations relevant to the non-relative donor procedure under Rule 18(3)/(7) — such as scrutiny of the “link,” “circumstances,” financial disparity, or absence of a middleman — into a case that is genuinely a near-relative case, since those heightened checks exist precisely because non-relative donation carries a higher risk of commercial abuse that the statute does not presume in near-relative donation.

Any such addition is ultra vires Rule 18 and has been struck down as arbitrary, or as vitiated by irrelevant considerations, in the decisions discussed above.

9. Directing the Hospital to “Confirm Authenticity” of All Documents — A Problematic Practice

A related but distinct practice is the Authorisation Committee or competent authority directing the transplanting hospital, as a further condition of approval, to itself “confirm” or independently verify the authenticity of every document filed — over and above what Rule 18 and Rule 5(3) of the THOTA Rules already ask the registered medical practitioner to satisfy himself about.

The registered medical practitioner already has a defined statutory duty under Rule 5(3)(c) of the THOTA Rules, 2014 — to satisfy himself that the donor is a near relative as certified in Form 5, that an application in Form 11 has been submitted, and that the necessary documents and medical tests have been examined to his satisfaction and that of the competent authority. This is a bounded, form-based duty.

It is a different thing altogether for the Committee to impose an undefined, freestanding obligation on the hospital to independently verify the authenticity of civil documents such as birth certificates or ration cards — a function hospitals have no statutory mandate, expertise, or investigative machinery to perform, and one that effectively shifts the Committee’s own Rule 18 evaluative function onto the hospital as an unlawful sub-delegation, while giving the Committee an open-ended excuse to keep an application pending.

Where genuine doubt about a document’s authenticity exists, Rule 18 itself (and the general scheme of the 2014 Rules) contemplates that doubt being resolved by the competent authority/Committee verifying the fact through the concerned officer(s) of the State Government or Union Territory Administration — not by an unlimited authentication burden placed on the hospital as a pre-condition dehors the rule.

Courts have consistently emphasised that delay in near-relative cases implicates the recipient’s right to life under Article 21, and have directed time-bound processing — for instance, the Delhi High Court’s directions (Justice Prathiba M. Singh) requiring applications to be processed within fixed timelines and deficiencies to be communicated promptly via defined channels. An open-ended “authenticity confirmation” mandate to the hospital, without statutory basis and without a defined timeline, runs counter to that constitutional and administrative-law direction.

10. Rule 14 and Form 20 — Residential/“Domicile” Verification Applies Only to Unrelated-Donor, Inter-State Cases

A distinct provision, Rule 14 of the THOTA Rules, 2014 (“Verification of residential status, etc.”), is often mistakenly imported into near-relative cases. Rule 14 provides that where the living donor is unrelated, and the donor or recipient belongs to a State or Union Territory other than the one where the transplantation is proposed to be undertaken, verification of residential status must be obtained from a Tehsildar or other authorised officer, with a copy marked to the Appropriate Authority of the donor’s/recipient’s home State, using Form 20. Rule 14 further provides that police involvement is triggered only contingently — the Appropriate Authority or Tehsildar is to inform the police department only “in case of any doubt of organ trafficking,” not as a routine, standing requirement for every application.

Two things follow directly from the text of Rule 14:

• It applies only when the donor is not a near relative. The rule’s opening words — “when the living donor is unrelated” — make this a condition precedent. It has no application to a genuine near-relative case at all, regardless of which State the recipient or donor resides in.
• Police reference is conditional, not automatic. Even within its own field of application (unrelated donors, inter-state cases), Rule 14 does not require a police verification certificate as a matter of course — only where the verifying authority has a doubt about trafficking, and even then the reference is for “investigation and action,” not a pre-condition certificate the applicant must produce before the file is even considered.

11. Demanding a Domicile Certificate in Near-Relative Cases Merely Because the Recipient Is Out of State — Illegal

It follows that where the donor and recipient are genuinely near relatives (say, mother and son, or spouses) but happen to reside in, or have travelled from, a State different from the one where the transplant hospital is located, the competent authority cannot lawfully insist on a “domicile certificate” or Form 20 residential verification as a pre-condition of approval. That requirement is textually confined by Rule 14 to unrelated-donor cases; Rule 18, which governs near-relative cases, contains no such condition at all.

Requiring it regardless is the same category of error the Madras High Court condemned in Atonu Saha — importing a check that belongs to a different, more exacting procedural track into a case where it has no statutory footing, and effectively penalising near relatives for the ordinary, lawful reality that patients frequently travel to another State for specialised treatment. Many of India’s major transplant centres are concentrated in a handful of cities, so out-of-state recipients and donors are the norm rather than the exception in near-relative cases — a domicile-certificate condition grafted onto Rule 18 would obstruct exactly the kind of urgent, legitimate donation the Act is meant to facilitate.

12. Demanding a Police Verification Certificate as a Standing Requirement — Not Supported by the Rules

For the same reason, a standing practice of insisting on a police verification certificate in every near-relative case — as opposed to the narrow, doubt-triggered police reference Rule 14 contemplates for unrelated, inter-state donations — has no basis in Rule 18. Rule 18 does not list a police clearance or verification certificate among the documents the competent authority is to examine for near-relative cases; the only reference to police/administrative verification anywhere in the 2014 Rules is the conditional one in Rule 14, confined to unrelated donors from another State, and triggered only where doubt of trafficking already exists on the material before the authority. Converting that narrow, contingent safeguard into a blanket documentary hurdle for every near-relative applicant — including, for instance, a mother donating to her own son within the same city — has the same defect as the DNA-test and affidavit practices discussed above: it adds a requirement the rule does not impose, delays a time-critical medical procedure, and cannot be reconciled with the “commonsense,” documents-first approach the courts have mandated.

13. A Drafting Recommendation: Replace “Domicile” with “Resident”/“Residential Status” in the Act and Rules

Rule 14’s own heading — “Verification of residential status” — is instructive. The body of the rule then lapses into the word “domicile” (“Appropriate Authority… of domicile of donor or recipient”), even though what is actually being verified is ordinary residence, not domicile in the strict legal sense. This is more than a stylistic quibble. In Indian law, “domicile” is a term of art tied to permanent home and intention to remain indefinitely, and Indian citizens generally have a single domicile of India rather than a distinct “domicile” of each State — state-wise “domicile” is itself a contested, inconsistently defined administrative concept in other contexts (educational quotas, for example), not a settled legal status. Using “domicile” in Rule 14, when the substance of the exercise is simply confirming where a person ordinarily resides for the limited purpose of routing inter-state Form 20 verification, invites exactly the kind of confusion that leads authorities to demand elaborate “domicile certificates” — a document with its own onerous, state-specific eligibility criteria — where a straightforward residence/address proof would suffice and would match what the rule is actually trying to verify.

For clarity and to prevent this kind of administrative overreach, the terminology in Rule 14 (and any corresponding reference elsewhere in the Act or Rules) would be better aligned with its own heading by consistently using “resident”/“residential status” rather than “domicile.” This would not change the substance of the safeguard — inter-state verification for unrelated donors would remain exactly as rigorous — but it would remove a loose, legally imprecise term that Authorisation Committees and competent authorities have sometimes used to justify demanding a formal domicile certificate (with its own bureaucratic delays) instead of simple, readily available residence proof, and would make it harder to misapply the requirement to near-relative cases in the first place.

14. Summary of the Governing Principles

15. Conclusion

The scheme of Sections 9(1) and 9(5)–(6) read with Rule 18 of the THOTA Rules, 2014, deliberately keeps near-relative donation on a lighter procedural track than non-relative donation, precisely because the risk of commercial exploitation that justifies the elaborate Authorisation Committee inquiry for unrelated donors is not presumed for genetic and spousal relationships. Recent High Court jurisprudence — most notably the Madras High Court’s decisions in Rita Chaurasiya and Atonu Saha, and the Bombay High Court’s decision in Prasanna Laxmikant Joshi — has repeatedly held that Committees and competent authorities exceed their jurisdiction when they import DNA-testing as a universal rule, demand consents or affidavits from persons Rule 18 does not require, condition a donor’s autonomy on a spouse’s approval, disregard adequate documentary proof, or otherwise travel beyond the specific heads of inquiry the rule sets out. The Supreme Court’s broader supervisory concern in the recent Indian Society of Organ Transplantation v. Union of India proceedings — directing uniform, time-bound, and donor-protective implementation of the THOTA framework across States — reinforces the same underlying principle: procedural gate-keeping must stay within the four corners of the statute and rules, so that genuine, time-critical, life-saving donations are not held hostage to requirements the law never imposed.

Note on sourcing: This article is written for general legal-awareness purposes. Case names, courts and dates are drawn from published law-report and legal-news coverage available at the time of writing. Readers relying on this for litigation should verify citations against the certified judgment/order before use, as neutral/SCC citations for the very recent orders were not uniformly available at the time of writing.

The analysis on domicile certificates, police verification certificates, and the recommendation to replace “domicile” with “resident” (Sections 10–13) is this author’s reading of the plain text of Rules 14 and 18 rather than a reported judicial holding on those specific points — no court decision squarely on those two practices was located at the time of writing.

Author: Prashant Ajmera, Advocate& Co-founder OneIndiaOneLaw.org Email: prashant@ajmeralaw.com