Due to many constraints and chiefly due to the unavailability of legal regulations for organ transplantations, kidney transplantation made a late entry to the arena of medical sciences in Nepal. The first successful kidney transplantation was performed in Tribhuvan University Teaching Hospital (Institute of Medicine - IOM) on 8 Aug, 2008. National Academy of Medical Sciences (NAMS) at Bir Hospital, started the services from 12 Dec of the same year. So far 71 transplantations have been carried out, 48 at IOM and 23 at NAMS. Not only has the services strengthened the medical facilities available in the country, but has effectively prevented a huge sum of money from draining into the neighboring countries, in addition to the trouble of getting the treatment and time spent on it.
It is estimated that about 2.7 million people are suffering from kidney diseases in Nepal and about two thousand add up to this number yearly. It is further estimated that nearly 750 kidney transplantations are needed in a year to meet the national needs, which accounts to about two transplantations a day. But due to various constraints prevalent, less than ten transplantations altogether in the two institutions, are being performed in a month.
One of the chief restraints worldwide is the unavailability of the organ donors, which is adding to the long waiting lists for transplantation. The current regulation in the country allows live human donors in direct relation to the recipient from the paternal side only. To meet the national need, it is time for modification of the existing regulations and allow live human donor from the maternal side as well as from generous well wishers, friends and non-relatives, but keeping a strict eye on prevention of organ trafficking and financial transaction. Allowing organ donation of deceased persons can be a great help to mitigate the problem to some extent. Organs of brain-dead individuals, diagnosed within 12 to 24 hours, can be procured and transplanted to those who need them.
To meet the national need, it is time for modification of the existing regulations and allow live human donor from the maternal side as well as from generous well wishers, friends and non-relatives.
Another grave problem is the unavailability of specialized setup for the transplantations. Although kidney transplantation services have started and are running smoothly, the backbone for such programs including availability of HLA typing and tissue typing facilities are not present in the country. This causes unnecessary delay while having to wait for laboratory reports from abroad as well as inflicting huge expenses upon patients. Likewise, there are no facilities for blood investigations for titration of immunosupression level and diagnosis of early or delayed graft rejection. A centeR dedicated to specialization in nephrology, urology and urgan transplantation with necessary gadgets needs to be established in the country. At present, the two institutions are providing the services as best as they can by utilizing their existing resources. The transplantations are being carried out smoothly merely because of the dedication and enthusiasm of the teams involved. More human resources production, training of young doctors and other human resources and encouraging them to choose this field as their future career can solve most of the prevalent problems.
As our country is marching ahead towards newer dimensions, it is high time that doors be opened to transplantation of other organs as well; after addressing the current problems faced in kidney transplantation. The responsibility needs to be shared equally by the government, the stakeholders and the public to promote organ transplantation in Nepal.
(Writer is the chief consultant and transplant surgeon at Bir Hospital, Kathmandu.)
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