Efforts should be launched by the government and others concerned to help reduce the number of kidney diseases in the country through various measures

In recent years there has been visible progress in the facilities provided to kidney patients and in the treatment of kidney diseases in Nepal, including transplantation. Apart from the technical and manpower aspects of kidney care, the legal aspects of kidney transplantation have also been made friendly to kidney transplantation, as reflected in the 2015 amendment to the Organ Transplant Act, 1998.

As a result, the first paired exchange of kidneys between two families took place just the other day. In this case, two (Niraula and Shrestha) families had a patient each with total kidney failure.

But no member of each family had a matching kidney for his or her suffering family member, but somebody in the Niraula family had a matching kidney for the patient of the Shrestha family and vice versa. The amended law permits kidney donation to husband, wife, siblings, maternal relatives, in-laws, and other relatives.

Indeed, the efforts of related doctors and kidney patients had been going on for over a quarter of the century to start kidney transplantation in Nepal itself. Bureaucratic delays, including in making a suitable law, had held up the process for years.

At that time Bir Hospital was the only place where physicians in kidney diseases, called nephrologists, were available. Planning and preparation too had been done for kidney transplantation there. Now, it should be noted with some satisfaction that there are a number of nephrologists in the Kathmandu Valley with some outside as well, and more dialysis centres as well.

Transplantation facilities are available at more than one hospital in the Kathmandu Valley. Yet these still fall short of the country’s present needs.

Now, even cross-matching of donor and recipient is done in Nepal, a process which is necessary before deciding whether a particular patient can take an organ from a particular donor. The outgoing government has done commendable work for kidney patients – it has made dialysis services free and given each transplant patient two lakh rupees.

The government realized the dilemma and difficulties of kidney patients and their families – dialysis and transplantation are very costly. Perhaps this was due to the fact that the outgoing Prime Minister, KP Sharma Oli, is himself a kidney transplant patient and has first-hand knowledge of what a total kidney failure means – for the patients and their families.

In the days to come more should be built on this solid initial work. In view of the increasing number of kidney patients in the country and the still inadequate facilities and the shortage of organ donors, most patients die soon after their kidneys totally fail to function.

In a country like Nepal a patient is unlikely to live for years just on dialysis; therefore, transplantation is the only way to enable the patients to lead a relatively normal life for several years to come.

In this context, work should also be seriously speeded up to utilize the kidneys, and even other organs like the liver and heart, for transplantation from brain-dead people. At the same time, efforts should be launched by the government and others concerned to help reduce the number of kidney diseases in the country through various measures, such as raising public awareness about their prevention.

Safer roads

Most of the roads being constructed in hilly districts, particularly in the remote far-west, or constructed have been done in a very risky manner without consulting the concerned experts.

It is said that technicians from the VDCs and DDCs are not permitting experts to carry the survey of the roads and are found designing the roads without going to the field to study them thoroughly.As a result, there are recurrent landslips in the roads under construction and those which already have been built.

Hundreds of local people have been displaced after landslide from a road near Titali village of Doti on June 20  blocked a stream. Water gushed into the village burying cowsheds as well. This is just an example of what the landslides have been doing to roads and settlements nearby putting human lives at risk.

The landslide in this village was caused due to dangerous manner in the use of bulldozers which made the land unstable in the area. An extensive feasibility study must be carried out to build safer roads in these hilly areas by studying the impact landslides could have on the ecology as well as human settlements.