Mother as Natural Guardian Can Solely Consent to Minor’s Life‑Saving Renal Transplant; Hospitals Cannot Insist on Absent Father’s Consent: Madras High Court

Case: A. Kasthuri v. State of Tamil Nadu & Ors., W.P. No. 35940 of 2025

Court: High Court of Judicature at Madras

Bench: Hon’ble Mr. Justice M. Dhandapani

Date of Decision: 18 September 2025

Introduction

This writ petition arose from an urgent, life-saving medical context. The petitioner, A. Kasthuri, a mother and primary caregiver to her 13-year-old son Joshua, challenged a hospital’s insistence on obtaining the biological father’s consent as a precondition for performing a renal transplant. The father had deserted the family in 2017. The hospital relied on “legal” requirements, citing the Transplantation of Human Organs and Tissues Act, 1994 (THOTA), to press for the father’s consent. The petitioner invoked Article 21 of the Constitution (right to life and health) and sought a mandamus directing the State-run hospital (Stanley Medical College and Hospital, Chennai) to proceed with the transplant without insisting on such consent.

The central legal issues were:

Whether a State hospital can insist on the father’s consent for a minor patient’s life-saving surgery when the father has deserted the child and the mother is the sole caregiver and natural guardian.
Whether THOTA mandates paternal consent for transplantation in the case of a minor recipient.
How Article 21’s right to health and the “best interests of the child” standard should guide hospital decision-making in critical pediatric care.

The parties included the State of Tamil Nadu (Health and Family Welfare Department), Directorate of Medical Education, the Dean and Head of Nephrology of Government Stanley Medical College and Hospital, and, notably, the local Inspector of Police (likely arrayed to assist in practical issues such as locating or verifying the absent parent’s status).

Summary of the Judgment

The Court disposed of the petition at the admission stage, recording the State’s assurance that appropriate care would be given and that the hospital’s decision would be taken immediately. It issued a specific direction to respondents 3 and 4 (the Dean and the Head of Nephrology, Stanley Medical College and Hospital) to:

Provide appropriate treatment for the renal transplantation of the minor Joshua forthwith.
Do so “without insisting any unreasonable demand” from the petitioner.
Complete the necessary steps within two weeks from receipt of the order.

Although brief and pragmatic, the order signals that insistence on the absent father’s consent is an unreasonable demand in the circumstances and cannot impede life-saving treatment, thereby implicitly recognizing the mother’s authority as natural guardian and the primacy of the child’s right to life and health.

Factual Background and Procedural Posture

Marriage of petitioner to Ayyappan: 27.08.2010; child Joshua born of the marriage.
Desertion: The husband deserted the mother and child in 2017; the mother has been the sole caregiver with support from her brother.
Medical condition: March 2025 diagnosis of Chronic Kidney Disease Stage V; on Continuous Ambulatory Peritoneal Dialysis.
Hospital insistence: By letter dated 05.05.2025, the Head of Nephrology (4th respondent) insisted on the father’s consent/signature for legal purposes under THOTA before proceeding with renal transplantation.
Relief sought: A mandamus to proceed with transplantation without paternal consent, within a timeline fixed by the Court.
Proceedings: State counsel accepted notice; the matter was taken up for final disposal at admission. The Court, recording State assurances, directed immediate, time-bound treatment without unreasonable demands.

The Core Holding and Its Immediate Effect

The Court directs that the hospital must proceed with the child’s renal transplant without insisting on unreasonable demands, implicitly including the father’s consent, and complete the process within two weeks. This effectively treats the mother’s consent as sufficient, especially in the context of a deserted spouse and urgent pediatric treatment needs. It affirms that administrative or documentary practices cannot trump constitutional imperatives and the legal framework governing guardianship and medical decision-making for minors.

Legal Framework and Reasoning

1) Transplantation of Human Organs and Tissues Act, 1994 (THOTA) and Rules

THOTA regulates the removal, storage, and transplantation of human organs and tissues, focusing primarily on donor authorization and the prevention of commercialization. It prescribes:

Conditions for living and deceased donation, including restrictions on minor donors and the role of Authorization Committees for non-near-relative donations.
Procedural safeguards against organ trafficking and requirements for medical boards and documentation.

Importantly, THOTA does not create a statutory requirement of “father’s consent” as a condition to transplant a minor recipient. Consent for the surgical procedure on a minor patient is governed by general principles of medical law and guardianship, not by a THOTA-specific paternal-consent mandate. Therefore, a hospital’s blanket insistence on the father’s signature finds no basis in THOTA when the mother is the natural guardian acting in the child’s best interests.

2) Guardianship under Indian Law

Under the Hindu Minority and Guardianship Act, 1956 (HMGA), the father is the natural guardian of a minor legitimate child, and “after him,” the mother. The Supreme Court in Githa Hariharan v. Reserve Bank of India (1999) clarified that “after” does not mean “after the lifetime of the father,” but in the sense of “in the absence of” or where the father is indifferent or not taking care of the minor’s affairs. In such circumstances, the mother is the natural guardian. In ABC v. State (NCT of Delhi) (2015), the Supreme Court further recognized the rights of a single/unmarried mother to act as sole guardian without mandatorily involving the father.

Here, the father had deserted the child since 2017; the mother has continuously acted as caregiver and legal representative. In that factual matrix, the hospital’s insistence on paternal consent is inconsistent with the law on natural guardianship and the best interests of the child.

3) Article 21: Right to Life and Health

The right to timely, life-saving medical treatment falls within the ambit of Article 21. The Supreme Court has consistently read into Article 21 the State’s obligation to provide medical care:

Pt. Parmanand Katara v. Union of India (1989): duty of every doctor and hospital, whether private or public, to provide immediate medical aid to preserve life.
Paschim Banga Khet Mazdoor Samity v. State of West Bengal (1996): State’s duty to provide adequate medical facilities; denial for administrative reasons violates Article 21.
State of Punjab v. Mohinder Singh Chawla (1997): right to health is integral to right to life.

In the present case, the Court’s direction embodies these principles: in matters of life-saving care for a child, administrative insistence on the father’s consent—where the father is absent—cannot impede treatment.

4) Informed Consent and Minors

In Samira Kohli v. Dr. Prabha Manchanda (2008), the Supreme Court set standards for informed consent in medical procedures for adults. For minors, consent is ordinarily obtained from a lawful guardian. Indian statutes (e.g., IPC provisions on consent) and medical ethics norms do not vest a 13-year-old with full legal capacity to consent to major surgery; hence a guardian’s consent is required. Either parent acting as natural guardian can provide it. There is no legal rule conferring a superior, exclusive consent-right on the father in these circumstances—especially where he has abandoned the child.

Precedents and Authorities: Context and Influence

The order itself does not cite case law. Nonetheless, the following precedents and legal principles supply the jurisprudential foundation for the result reached:

Githa Hariharan v. Reserve Bank of India, (1999) 2 SCC 228
Clarified that the mother can be the natural guardian during the father’s lifetime where the father is absent, indifferent, or fails to care for the child’s interests. This directly undermines any institutionally entrenched assumption that the father’s consent is always a prerequisite for medical decisions concerning minors.
ABC v. State (NCT of Delhi), (2015) 10 SCC 1
Recognized a single mother’s right to be the sole guardian of a minor and the possibility of excluding the father’s involvement in circumstances where compelling reasons exist. This bolsters the proposition that compelling a mother to secure the father’s consent, especially when he is absent, is neither necessary nor lawful.
Pt. Parmanand Katara v. Union of India, (1989) 4 SCC 286
Emphasized the duty of medical institutions to provide immediate medical aid; the protection and preservation of human life are paramount.
Paschim Banga Khet Mazdoor Samity v. State of West Bengal, (1996) 4 SCC 37
Established the State’s positive obligation to ensure adequate medical facilities and empower procedural responses to emergency care—administrative hurdles cannot thwart treatment.
State of Punjab v. Mohinder Singh Chawla, (1997) 2 SCC 83
Deepened Article 21’s scope to include access to health, relevant here to resist non-statutory impediments to life-saving treatment.
Samira Kohli v. Dr. Prabha Manchanda, (2008) 2 SCC 1
Sets the benchmark on informed consent. For minors, consent must come from lawful guardians; this case, while about adult consent, frames the ethics and legality that extend by parity of reason to guardian-consented procedures.

Read together, these authorities strongly support the Court’s result: the mother, as the lawful guardian in the factual scenario of desertion, is fully competent to authorize the transplant, and the hospital cannot rely on a non-existent statutory requirement to withhold care.

Legal Reasoning: How the Court Reached Its Decision

While the order is concise, the reasoning can be distilled as follows:

Primacy of the child’s right to life and health under Article 21: The Court prioritizes immediate, life-saving intervention, consistent with constitutional jurisprudence and the State’s obligations.
Mother’s status as natural guardian: Given the father’s desertion since 2017, the mother acts as the natural guardian under the HMGA as interpreted by the Supreme Court. Insisting on the father’s consent is legally unsustainable.
THOTA compliance preserved; paternal consent not mandated: The Court does not dilute THOTA’s safeguards regarding donor authorization, Authorization Committee processes for living unrelated donors, etc. It simply rejects a non-statutory, unreasonable administrative demand—paternal consent for a minor recipient—when a lawful guardian is available and acting in the child’s best interests.
Pragmatism and urgency: The Court time-binds the hospital to act within two weeks, preventing administrative deferral and avoiding the deterioration of the child’s health.

Impact and Implications

A) Immediate Operational Impact on Hospitals

Hospitals in Tamil Nadu, and by persuasive effect elsewhere, should revise consent protocols to recognize that:
- Either parent can consent for a minor; the mother’s consent cannot be subordinated to the father’s in law.
- Where the father is absent, the mother’s consent as natural guardian suffices.
- Demands such as “father’s signature,” “no-objection from father,” or “police certificate to trace father” should not delay life-saving treatment when a lawful guardian is available.
Standard operating procedures and consent forms should be updated to align with guardianship law and Article 21 obligations.
Clinical ethics committees and Authorization Committees (for living donations) should record the guardian’s status and proceed without insisting on non-statutory consents.

B) Clarification of Law for Single-Parent and Desertion Contexts

The decision advances clarity for single mothers, widows, divorced or deserted spouses seeking critical medical care for minors.
It supports the principle that parental presence or participation cannot be made a rigid precondition if the absent parent is not a caregiver and the other parent is a lawful guardian.

C) Child Welfare and Best Interests Standard

By removing procedural bottlenecks, the judgment strengthens the “best interests of the child” paradigm in clinical decision-making.
Delays caused by documentary requirements not grounded in law may constitute violations of the child’s rights under Article 21 and the UN Convention on the Rights of the Child’s principles, to which Indian jurisprudence often looks for guidance.

D) Future Litigation and Administrative Guidance

Expect fewer petitions seeking similar directions once departments issue clarificatory circulars. The Health Department and DME can proactively codify this approach in policy.
In disputes where the absent parent reappears with objections, courts will likely assess on a case-by-case basis, with the child’s best interests and medical urgency remaining paramount.

Complex Concepts Simplified

Writ of Mandamus: A command from a constitutional court to a public authority to perform a duty imposed by law. Here, to provide urgent, lawful medical treatment.
Natural Guardian: The person legally recognized to care for and take decisions for a minor. Under HMGA, the mother can be the natural guardian where the father is absent/indifferent, per Githa Hariharan.
THOTA (1994) and Rules: A law regulating organ and tissue transplantation. It governs donor consent and anti-commercialization safeguards. It does not require a father’s consent for a minor recipient’s surgery when the mother/guardian consents.
Informed Consent for Minors: Minors generally lack legal capacity to consent to major medical procedures; a lawful guardian consents on their behalf.
Article 21 – Right to Life and Health: The Constitution guarantees not just life but a life with dignity, encompassing access to emergency and essential medical care. Administrative formalities cannot defeat life-saving treatment.
“Without insisting any unreasonable demand”: In context, this phrase primarily targets the insistence on paternal consent, but also cautions against other extra-legal hurdles that delay urgent care (e.g., rigid insistence on documents not required by law).

Practical Compliance Checklist for Hospitals (Illustrative)

Identify the lawful guardian of the minor (mother/father/other guardian appointed by court); record basis (e.g., desertion, custody orders, affidavits).
Obtain informed consent from the lawful guardian; document in standardized forms.
Proceed with all THOTA-mandated donor-side approvals (Authorization Committee clearances for living unrelated donors, medical board opinions, etc.).
Do not delay life-saving care due to non-statutory documentary demands (e.g., absent father’s “No Objection”).
Constitute hospital committees promptly; adhere to time-bound steps especially where court directions specify timelines (here, two weeks).

Limitations of the Order

The order is succinct and does not elaborate doctrinally on THOTA or guardianship law. It does not dilute THOTA’s donor-side safeguards. The Court’s directive should not be misconstrued as relaxing statutory checks against organ trafficking or as a blanket waiver of all documentation; rather, it removes only unreasonable, non-statutory impediments—chiefly the insistence on paternal consent where the mother is a lawful guardian and the treatment is life-saving.

Conclusion

The Madras High Court’s order establishes a clear and humane principle with practical force: a hospital cannot insist on an absent father’s consent as a precondition to a minor’s life-saving renal transplantation when the mother, as the lawful guardian, has consented. Grounded in Article 21’s guarantee of life and health, and consistent with Supreme Court jurisprudence on guardianship and medical aid, the judgment aligns medical practice with constitutional values and statutory design. It instructs public hospitals to act promptly, avoid extra-legal impediments, and center the child’s welfare in clinical decision-making.

Key takeaways:

Mother’s consent suffices where the father has deserted or is otherwise absent; there is no THOTA requirement for paternal consent to a minor recipient’s transplant.
Article 21 demands that life-saving treatment not be delayed for non-statutory formalities.
Hospitals should update SOPs to reflect lawful guardianship principles and the primacy of the child’s best interests, ensuring time-bound care.

In sum, the decision strengthens minor patients’ access to urgent, life-saving interventions and affirms the legal agency of single or deserted mothers to act decisively in their children’s best interests.