Raj Kumar Shrestha from Sanepa, who had his transplant in 2009, while waiting, said the medical procedures have been smooth.
“The service is effective,” said the 28-year-old. “If not I would not have survived.”
The facility at TUTH has been providing services such as dialysis and transplantation for patients with kidney problems.
“We can treat all types of kidney diseases here in Nepal,” said Dr Dibya Singh, the first renal transplant physician in Nepal.
The facility that started the transplant in August 2008 has so far completed 48 transplantations. She said that there is transplantation every week and due to a long list, patients usually are put on a three-month wait.
But while they wait for transplant, patients undergo a dialysis process, which replaces the kidney functions, a four-hour schedule every two to three times a week. The process is not only time consuming but also a financial burden for people with limited means. The monthly cost of dialysis costs around Rs 25,000.
While dialysis can take care of “the clearance part, it cannot produce hormones that the body requires,” Dr Singh said.
Of the major functions of kidneys, it helps in the excretion of the byproducts and toxins produced from metabolism which are harmful for the body. The kidneys also help in the balance of water and electrolyte and helps in the excretion of excessive water from the body, Dr Singh said.
They also balance the level of minerals such as potassium and sodium required by the body and is responsible for producing hormones to produce the Red Blood Cells and active form of Vitamin D required by the body.
While dialysis is only a temporary solution to the problem, “transplant can take care of all the functions and the quality of life is much better,” she said.
But the challenges related to this disease are complex since symptoms don’t appear at initial stage unlike most of the diseases.
Even until the kidney is 50 percent damaged, they can still function properly, Dr Singh said. “Only after the kidneys are damaged 70 percent, the symptoms appear.”
Symptoms could range from body and ankle swelling to loss of appetite, very high blood pressure, puffy eyes, decrease in blood level and lethargy to name a few.
But Dr Singh pointed that the difference between kidney failure and kidney-affected diseases. She said that kidneys could be affected by other diseases and infections too. For instance in case of very low blood pressure, the blood can’t be supplied to the kidney and so it stops functioning temporarily.
Kidney can be temporary damaged due to other diseases and during such cases if treated within three months, the kidney can be stopped from permanent failure, Dr Singh said.
“Kidney failure means that it has stopped functioning at all and then life cannot be sustained.”
But even in cases of transplantation, perhaps the last option, the process isn’t easy before and after the transplantation.
A thorough assessment of the donor and the recipient, almost month-long tests, are done and made sure that there are no chances of any infections that could spread later, Dr Singh noted. As the recipient’s immune system becomes very weak, there are chances that infections and diseases spread rapidly. Also, it could affect other parts of the body.
“Once the kidney is failed, it impacts many organs—heart problem is a major,” she said. “A patient with kidney transplant is prone to 3 to 5 times more of
having heart disease than normal person.”
And even after the transplantation, there should be effective follow-ups. Possibly, patients have to visit a doctor 3 to 4 times a year their entire lifetime, Dr Singh said.
The approximate cost for kidney transplantation in Nepal costs between Rs 2 to 3 lakhs but could go up depending on nature of complexities, Dr Singh said. But money isn’t only constraint for many. The Nepali law restricts donating a kidney unless it is within the family.
Dr Singh said that the laws should be revised so that close friends and distant relatives could also voluntarily donate if they desire. She said organ swapping could be another option where two parties having similar problems could donate under mutual understanding. Also, cadaver donor program can also be implemented, she added, where if someone is brain dead or wants to donate organs after death, the organs can be used for a patient. In case of kidneys, they have to be transplanted within 48 hours in case of the cadaver program.
But the consultant nephrologists don’t overlook the illicit trading of organs in Nepal and India, and especially kidneys.
“Brokers are really exploiting donors and recipients,” she said. “We should always make sure that organ traders don’t come in between.”
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