From 2021 to 2025, Tamil Nadu’s major organ transplants increased from 280 to 785, marking a 180% rise. Kidneys and livers remain the most used organs, with utilisation rates averaging 80% to 90%. However, heart and lung transplant rates are much lower due to organ-specific challenges. The number of deceased donors in Tamil Nadu also rose from 156 in 2022 to 240 by November 2025. Yet, only 27.08% of hearts and 17.91% of lungs from donors were used in 2025. In 2024, the utilisation was 35.82% for hearts and 16.61% for lungs. An official explained, “Globally, lung utilisation rates are low. One of the common reasons for rejecting lungs is donor-recipient size mismatch. The organ retrieval team often finds infections or issues during bronchoscopy, leading to rejection. Prolonged ventilation can damage lungs. We should focus on speeding up the process and preventing sepsis.” Dr. Paul Ramesh from Kauvery Hospitals said the ischemic time—how long the organ can stay viable without blood—is crucial. “Heart transplant time ranges from four to six hours, lung transplant time is eight to 10 hours. About 70% to 80% of donor kidneys and livers are usable. For hearts, only 25%-30% and lungs 15%-20% are usable due to these time limits.” Dr. D. Senthil Kumar from Rela Hospital said they thoroughly review medical reports before transplanting hearts and lungs. He noted that lungs are often rejected because of infections, aspiration, or ventilator lung damage. “In about 10 donor assessments, only three to four hearts and one lung are found usable after checking all vital signals and ischemic time.” Experts say better cadaver management is key to improving organ use. Maintaining donor organs carefully and acting quickly after brain death can save more hearts and lungs. Dr. Ramesh added that liver and kidney transplants are easier because many centres perform them nearby, reducing travel time. Hearts and lungs must be transported quickly within tight time limits, which is harder due to transport logistics and costs. Dr. Senthil Kumar highlighted challenges in remote areas like Salem and Thoothukudi where commercial flights are limited. Teams often need chartered flights or helicopters, increasing costs that patients bear. Optimising donor heart and lung condition is vital. Experts call for better management of donor care, careful use of medications, and rapid organ retrieval to increase successful heart and lung transplants in Tamil Nadu.