Here in Nepal, a country remarkable for it's beautiful mountain range - the
Himalayas - and a friendly people, nephrology is a young specialty. Kidney Transplantation is even younger as a clinical service.
Some background: I spent a few days in Kathmandu time talking to leading nephrologists in the country - Dr. Rishi Kafle and Dr. Dibya Singh Shah. There are 22 nephrologists serving a population of approximately 30 million. NSN was founded in 1998 at the urging of Dr. Kirpal Chugh. At the time there were only about 5 nephrologists in the country. There has been some growth since then, both in the number of nephrologists and dialysis facilities. I visited the National Kidney Center a multi-story dialysis facility with over 40 machines, dialyzing patients in a setting comparable to many quality facilities around the world. However, with 3 million people with chronic kidney disease living in a low-to-middle-income economy many cannot afford dialysis (the cost is approximately 3000 Nepalese Rupees or USD $30 per treatment, mostly twice weekly). While the government helps by subsidizing or even covering the cost of dialysis it cannot do so for everyone indefinitely. Unfortunately, at least for now, kidney transplantation is not the whole answer.
The first kidney transplant program in Nepal was launched in 2009 by Dr. Dibya Singh Shah at Tribhuban University Teaching Hospital (TUTH) with the help of an Australian transplant surgeon. Over 200 transplants have been performed, but these are exclusively living related. Launching and maintaining a quality kidney transplantation has been a heroic effort on the part of Dr. Dibya Singh. Many in her place would probably not pulled off what she has done.
However, more needs to be done. No living unrelated transplants are allowed under Nepalese law and there is no deceased donor program.
The government of Nepal needs to change it's policy on unrelated donor transplantation. By not allowing this to happen, a sizable number of patients are denied the opportunity of receiving a transplant and a new lease on life. It is a pity that the price of avoiding a small number of bad actors doing commercially motivated transplantation in Nepal means patients who have an unrelated donor being unable to undergo transplantation. It doesn't seem either feasible or sensible to limit a whole country to an approach that is essentially driven by fear.
Some background: I spent a few days in Kathmandu time talking to leading nephrologists in the country - Dr. Rishi Kafle and Dr. Dibya Singh Shah. There are 22 nephrologists serving a population of approximately 30 million. NSN was founded in 1998 at the urging of Dr. Kirpal Chugh. At the time there were only about 5 nephrologists in the country. There has been some growth since then, both in the number of nephrologists and dialysis facilities. I visited the National Kidney Center a multi-story dialysis facility with over 40 machines, dialyzing patients in a setting comparable to many quality facilities around the world. However, with 3 million people with chronic kidney disease living in a low-to-middle-income economy many cannot afford dialysis (the cost is approximately 3000 Nepalese Rupees or USD $30 per treatment, mostly twice weekly). While the government helps by subsidizing or even covering the cost of dialysis it cannot do so for everyone indefinitely. Unfortunately, at least for now, kidney transplantation is not the whole answer.
The first kidney transplant program in Nepal was launched in 2009 by Dr. Dibya Singh Shah at Tribhuban University Teaching Hospital (TUTH) with the help of an Australian transplant surgeon. Over 200 transplants have been performed, but these are exclusively living related. Launching and maintaining a quality kidney transplantation has been a heroic effort on the part of Dr. Dibya Singh. Many in her place would probably not pulled off what she has done.
However, more needs to be done. No living unrelated transplants are allowed under Nepalese law and there is no deceased donor program.
The government of Nepal needs to change it's policy on unrelated donor transplantation. By not allowing this to happen, a sizable number of patients are denied the opportunity of receiving a transplant and a new lease on life. It is a pity that the price of avoiding a small number of bad actors doing commercially motivated transplantation in Nepal means patients who have an unrelated donor being unable to undergo transplantation. It doesn't seem either feasible or sensible to limit a whole country to an approach that is essentially driven by fear.
