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HEALTHCARE STRUCTURE AND ECONOMICSOrgan transplantation in India to date relies predominantly (80.3%) on living donor procedures for kidney and liver transplantation. Heart, lung, pancreas, and small bowel transplants are therefore less frequent. [1][2][3][4] There is also a pronounced gender inequality with a majority of male transplant recipients (81%), whereas most donors (78%) are female. At this time, there are limited living donor follow-up and variable recipient results. Most transplants take place in private sector hospitals with costs that nearly twice compared with those in the public sector.India ranks 184 of 191 countries for the gross domestic product (GDP) spent on healthcare. Based on the World Health Organization National Health Profile, India spent only 1.3%-1.4% of its GDP for public health expenditures (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019)(2020). In comparison, health expenditures (% GDP) are significantly higher in developed countries, ranging from 17% in the United States to 9.2% in Australia. Approximately 30% of healthcare in India is funded by the government, whereas 70% is funded outof-pocket; 50% of healthcare in the country is provided by private institutions. Ayushman Bharat Mission-National Health Protection Mission or Pradhan Mantri Jan Arogya Yojana has been launched in 2018, the Around the World T1-T3,F1

Coronavirus disease (COVID-19) vaccine and its utility in solid organ transplantation (SOT) needs to be revised timely and updated. These guidelines have been formalized by the experts -the apex technical committee members of the National Organ and Tissue Transplant Organization (NOTTO), and the heads of transplant societies for the guidance of transplant communities. In our general recommendations, we recommend that all personnel involved in organ transplantation should get vaccinated as early as possible and continue COVID-19 appropriate behaviour, despite a full course of vaccination. For specific guidelines of recipients, we suggest completing the full schedule before transplantation whenever the clinical condition permits. We also suggest a single dose, rather than proceeding unvaccinated for transplant, in case a complete course is not feasible. In case, vaccination is planned before surgery, we recommend a gap of at least 2 weeks between the last dose of vaccine and surgery. For those not vaccinated prior to transplant, we suggest waiting for 4-12 weeks after transplant. For the potential living donors, we recommend the complete vaccination schedule before transplant. However, if not feasible, we suggest getting at least a single dose of vaccine, 2 weeks prior to donation. We suggest that suitable transplant patients and those on the waiting list should accept a third dose of the vaccine when one is offered to them. In the context of Vaccine-induced thrombotic thrombocytopenia (VITT), we recommend organs from a deceased donor with suspected/proven VITT should be notified and best avoided and are justified only in case of emergency situations with informed consent and counselling.

In December 2019, novel coronavirus (SARS-CoV-2) infection started in Wuhan and resulted in a pandemic within a few weeks' time. Organ transplant recipients being at a risk for more severe COVID-19 if they get SARS CoV-2 viral infection, COVID-19 vaccine has a significant role in these patients. The vaccine is a safer way to help build protection and would either prevent COVID-19 infection or at least diminish the severity of the disease. It would also reduce the risk of the continuing transmission and enhance herd immunity. Immuno-compromised patients should not receive live vaccines as they can cause vaccine-related disease and hence the guidelines suggest that all transplant recipients should receive age-appropriate 'inactivated vaccine' as recommended for general population. Though trials have not been undertaken on transplant recipients, efficacy and safety of COVID-19 vaccine have been scientifically documented for few vaccines among the general population.