For kidney transplantation to become successful, total care should be available and that should be of high standard

Recent advancements made in organ transplantation on humans are very encouraging. It has helped save the lives of hundreds of thousands. Nepal too has been able to successfully carry out kidney transplants. As a result, many kidney patients do not have to go abroad any longer and spend a huge amount in order to have them transplanted. At present, the Human Organ Transplant Centre at Bhaktapur has been providing services for kidney transplants. The increasing number of kidney patients in the country makes adequate facilities for the treatment of kidney diseases, including transplantation services, at home all the more necessary. About 3000 people die from renal failure in Nepal every year, and only 10 per cent live with the disease. The centre says it has the necessary equipment and personnel to carry out transplants of the liver, lung and also heart surgeries. The services will be initiated after the presidential authentication of the bill dealing with carrying out amendments to the Human Body Organ Transplant Act.

The new amendment will pave the way for the removal of organs such as the liver, heart, pancreas and small intestine from those who are “clinically dead” to be transplanted to those who require them. The first hurdle to cadaver transplantation is thus removed. A clinically dead person’s organs could save the lives of eight people. The Act however fails to address the role of surgeons who carry out the transplants. This needs mulling over because the surgeons could get away even when they have not carried out the surgeries properly. Legal provision has it that the doctor who declares someone clinically dead cannot transplant the same organ to others who need it. But there are several problems standing in the way of making cadaver transplantation programme successful, including the problems of the state-of-the-art technology, expertise, and cultural inhibitions.

Kidney patients are particularly hit hard because treatment of kidney failure is very expensive, including the need for regular dialysis, transplantation and post-transplant long-term care and medication, each of which costs a lot of money. As far as possible all the necessary steps should be taken to make such services available without hassles. The people should also be made aware of the various diseases, including the kidney diseases, in the school curriculum so that they can take preventive measures. Those with kidney problems should also be put in the list of the physically challenged and they should benefit from reasonable government subsidies. The amount provided now is far from adequate. Moreover, when full cadaver transplant services are made available in the country, people should be encouraged to donate their organs. The efforts to make kidney transplantation possible in Nepal have been going on for about a quarter of a century. But problems arose at various stages, and it has taken too long for the efforts to become successful. For kidney transplantation to become successful, total care should be available and that should be of high standard. The efforts being made in Nepal to that end should be continually raised to achieve the highest possible standard.

Learn lessons

It is not surprising that revenue collection of the government has dropped sharply in the first half of this fiscal year. Last April a major earthquake struck a number of districts of the country; and as if that were not enough, the unrest in the Tarai, the related violence and vandalism and the blockade on Nepali imports in quick succession have caused the revenue to plunge. The government collected only Rs.164.33 billion as against the target of Rs.216.60 billion. The Customs Duty constitutes the single largest source of government revenue, but its collection amounted to just two-thirds of the target. Similarly, collections of other types of revenue, including income tax, VAT and excise fell short of the targets.

While economic activity, including export and import, goes down, revenue collection naturally goes down too. The economy as a whole has taken a tumble with the economic growth rate for this year projected to hover somewhere near zero. The low revenue collection is only one of the symptoms of the economic disaster that the earthquake, the Tarai unrest, and blockade on imports, including import of petroleum products, have triggered.