Long-felt need

It is reported that the Teaching Hospital at Maharajgunj has ‘successfully’ carried out transplantation on two kidney patients over the past week. Doctors involved in the operation have said that they will bring out all details soon, and organ recipients are currently under special medical supervision in hospital. The hospital has brought in Australian doctors to help with the transplantation. It is a wise decision, because Nepali doctors lack sufficient experience and expertise in the field. Though the Teaching Hospital has become the first in Nepal legally to do renal transplantation, a couple of kidney transplants had indeed been performed in the 1990s, though illegally, at a private nursing home at Naya Baneswor, without full medical preparations. As a result, the organ recipients died soon afterwards.

At first, Bir Hospital had made most of the preparations for kidney transplantation, but for lack of adequate laws and regulations, and perhaps for some other reasons, too, the idea could not get off the ground. The government promulgated an organ transplantation law nearly a decade ago, and the relevant regulations about seven years ago. It is hoped that the just started service is continued with a high success rate. For this, foreign expertise will continue to be needed until all the Nepali surgeons, physicians and other medical experts in this particular area become fully confident and competent. The importance of a very high level of expertise and experience is felt acutely when complications arise during or after the operation. Doctors said that the transplants were done ‘successfully’, but in the case of kidney transplantation, it is too early to make such a sweeping generalisation.

Among the complications that may arise, the most important is the rejection syndrome — when the recipient’s body begins to show signs of rejecting the foreign body. Then anti-rejection treatment is called for, which includes using a wise combination of immuno-suppressive drugs. The appearance of these symptoms is fairly frequent, all the more so in recipients of organs from outside near blood relations. It may take days and sometimes even weeks to cure rejection, but in certain cases, the body finally discards the organ. It is on the basis of the survival rate of the donated organs — say, during the first year, the second year, the fifth year, the seventh year, and the tenth year — that the success rate of transplantation is judged. Transplantation needs total care before, during and after the operation. And medical care, particularly of renal physicians (nephrologists), lasts as long as the patient is alive. So successful transplantation is much more than taking the organ out of the donor’s body and implanting it in the recipient’s. The hospital should take further measures wherever shortcomings may appear, because a rejection means a huge loss for the patient, the donor, and the relatives, not just in monetary terms. The availability of this service at home will save a lot of money for the patients, and the country, as well as a good deal of inconvenience. Attention should gradually be directed towards exploring the possibility of cadaver transplantation, because of the shortage of live donors.