1. Organ Failure in Nepal: Rapidly Growing Challenge for All
Dr. Pukar Shrestha,
Executive Director and Transplant Surgeon
Human Organ Transplant Center (HOTC)

2. Status of Organ failures in Nepal
Estimated figure -
3000 Renal failure / yr
1000 Liver failures / yr
3 millions diabetics
No data on heart or lung failures

3. Status of Kidney failure
Estimated worldwide dialysis population
> estimated figure was 2 million by 2010
3000 patients develop renal failure every year in Nepal
Only 10% of kidney failure patients might reach dialysis
90% of kidney failure patients die within few months in South Asia
Worse in Africa

4. Challenges Policy issues 2. Lack of awareness:
Donors from close relatives only
Cadaveric transplantation not started
2. Lack of awareness:
Lack of regular check up
Organ trafficking
Going for illegal and expensive transplantation abroad
Economic Issues
Nepal losing about Rs. 6 billion yearly
4. Gender issues
5. Limited infrastructures

5. History of Organ Transplantation in Nepal
Renal transplants carried out in a private hospital in Nepal on 1997,
Formal renal transplant was done on 2004 at Bir hospital.
Service resume on 2008 at two centers of Nepal- TUTH and Bir Hospital.
Cornea Transplant
Bone marrow transplant

6. Who should solve this problem?
Government
Non Governmental organizations
Private Organizations
International organizations

7. Human Organ Transplant Center: Estd
Human Organ Transplant Center: Estd. in 2012 : New Hope for Organ failure patients !

8. Haemodialysis machines 40
CRRT

10. HOTC : Dialysis & Transplant Service Cheapest
Haemo/Peritoneal from Nov. 2012
Free for underprivileged
Charge Rs ($ 12) / session for all
CRRT:
1. Resistant rejections
2. Critically ill patients
Renal Transplant cost : $

13. Our Transplant (HOTC/ Bir) Results
Dec – Jan 2014 (5 yrs)
179 live donor renal transplants (HOTC 80, Bir 99)
All recipients were males except 20 Females
Age ranged from 15 to 66 yrs, mean 37yrs.
Primary diseases of recipients –
Chronic Glomerulo-nephropathy / Hypertensive 52%
Obstructive uropathy %
Diabetes mellitus %
Alport’s syndrome %
Unknown % 13

14. Outcome of Renal Transplantation
All grafts had immediate function
99% patients discharged after operation
Delayed graft function: 5% % (world)
Rejection rate : %. 20% (world)
(8/10bx+)
Surgical site infection : 2.0 % 2-25% 14

16. Gender Bias
Recipients :
M 87% vs F 13%
Donors:
M 24% vs F 76% 16

17. Relationship

18. Aarogya Foundation: “not for profit”organisation

19. Lab facility for transplantation: HLA

20. Taccrolimus level monitoring

21. Awareness campaigns

22. 1st Transplant Game in Nepal
Final Score 3:0
Won by transplantees
100m race

24. 6th Nepal Transplang Games 2072

25. Working with Govt. policy
Financial support:
Free dialysis for marginalized people for 2 year
Grant for Renal Transplant: US$ 2000
Grant for Post Tx medications: US$ 1000
Expanding Haemodiaysis services across the country
Expansion of Live donor pool &
Initiate Deceased donor transplants
Bringing regulations for Liver transplant

26. Brain Death Donor Transplantation
About 1000 brain deaths / yr in Nepal
At least 8 major organs from ‘brain dead’ donor – 2 kidneys, 2 lungs, 1 liver, 1 Heart, 1 Pancreas, 1 small intestine
80% Transplants from such donors in developed country
Brain Death Criteria for Nepal: already formulated
Draft waiting for approval from govt.
HOTC ready to start brain death donor transplant

30. Joint effort of HOTC & Aarogya To address Gender Biasness
Financial support
When Male donates organ to Female
50% of the service charge for Tx in HOTC

31. Conclusion
Renal Transplantation in Nepal is now well established service with ‘world class’ result possibly at the cheapest price.
A lot to be done to meet the transplant demand
Cost of post transplant medications & Employment
Brain Death Donor Transplantation
Multi-organ transplant e.g
Liver transplant is our next dream
Newer techniques & medications

32. Prevention is better than cure
Control your diabetes and blood pressure
Control body weight
Balanced diet
Regular Exercise
Take plenty of fluid
No tobacco and alcohol
Regular health check up

33. Thank You