National 7 (Spotlight Weekly)

Difficult Start

The complications in the first kidney transplant should compel the doctors and health administrators to become more alert

By THAKUR AMGAI

After years of wrangling over legal issues related to organ transplant and the ability of the Nepali doctors to conduct the surgery, the Ministry of Health has finally licensed Bir Hospital, the country's oldest hospital, to conduct the renal replacement surgery. Twelve kidney patients are undergoing the transplant surgery under the first phase.

The first surgery took place at Bir Hospital on 26th of November by a joint team of Dr. Ashok Rana and Dr. Arjun Dev Bhatta. A kidney donated by his mother was transplanted to Pradeep Chaudhary. Four others in queue for the surgery have been sent to Indian hospitals for blood tests required before undergoing the surgery.

The grim side of the story, however, is that the very first surgery has become unsuccessful. According to reliable hospital sources the renal replacement on Chaudhary had failed and the patient is undergoing haemo-dialysis-treatment for patients with kidney failure before the kidney is replaced. The authorities have neither confirmed nor denied the failure.

"We have decided not to disclose anything until we complete the first twelve surgeries," said Dr. Damodar Pokhrel, medical superintendent of Bir Hospital. "It is our policy-level decision."

Doctors involved in the surgery refuse to make any comment at all.

Although, a pioneering event, the surgery was conducted without any other nephrologists present in the theatre. Despite the hype, the media as well as the transplant patients were not informed of the surgery.

There had been lots of speculations about kidney transplant in Nepal since last few years. Many a time, the health ministers had announced that the kidney transplant would begin shortly.

The doctors had been shying away from starting the surgery because of legal hassles, which had provisions of stringent penalty to the concerned doctor if the donor died within one year of the surgery. The door to legally transplant kidney was opened last year after the law was amended.

Even after the law was amended, the Ministry of Health had not given permission to Nepali hospitals to conduct the renal transplant surgery on the grounds that Nepalese doctors were not experienced or trained for the transplant. There are only 10 nephrologists in the country out of which none are trained or experienced for the kidney transplant. In addition, the transplant surgery had been delayed because of the internal tug of war between the health institutions to conduct the first surgery. Government-owned hospitals do not want the private ones to get the permission, while the private ones are demanding equal rights. For now, the government has given permission to Bir Hospital only to conduct the surgery.

The ministry had earlier planned to call Indian doctors for the surgery. However, it later decided to send the Nepali doctors for training instead.

With this beginning, other institutions are also likely to get permission and conduct renal surgery in the subsequent months. The present incident has alerted all others involved in the field. "This (without mentioning the word 'failure') fate of the pioneering case has given message to the followers to take enough caution before undertaking any surgery," alerted Dr. Rishi Kumar Kafle, a prominent Nephrologist of the country. "Otherwise, the whole system of Kidney transplant might shake."

The sale of human organs is illegal in Nepal. Kidney can be donated by only very close relatives of the recipient. To control the illegal sale, even donation by an outsider is considered illegal in Nepal. However, almost all of the transplants take place from donors outside the family.

To the majority of Nepalese, whose per capita GDP is less than Rs. 100,000, kidney failure means death. They can neither afford to continue the haemo-dialysis, which costs at an average of Rs. 10,000 to Rs. 15,000 per month in government hospitals and more than Rs. 35,000 per month in private ones; nor can they afford the post surgery medications which costs Rs. 10,000 to Rs. 20,000 per month for the first year after the transplant and at least Rs. 5,000 per month afterwards. So, far, at least 400 Nepalis have undergone the renal surgery from Indian hospitals.