World Kidney Day is being celebrated today across the world with various events. The theme of this year's World Kidney Day is "Kidney Health for All – Advancing equitable access to care and optimal medication practice".

According to a 2008 study by the World Health Organisation, over 90 per cent of kidney failure patients in developing nations like Nepal faced a grim prognosis, with many succumbing within months. With no kidney transplant facilities and limited dialysis services domestically, majority of the Nepalis couldn't afford treatment abroad. Even those lucky enough to access dialysis often struggled to cover the hefty monthly costs ranging from Rs. 40,000 to 50,000.

By the end of 2008, kidney transplantation commenced at the Bir Hospital and Tribhuvan University Teaching Hospital, instilling hope for kidney patients' survival. Over the next four years, 99 individuals underwent kidney transplants at the Bir Hospital, setting the stage for a significant advancement in kidney treatment in Nepal.

Recognising this success, the Government of Nepal, Ministry of Health and Population decided to inaugurate a specialised hospital in 2012 to cater to individuals with organ failure. This led to establishment of the Shahid Dharmabhakta National Transplant Centre (SDNTC) at Bhaktapur in 2013, serving as a cornerstone for the nationwide expansion of dialysis and kidney transplantation services. Its establishment has facilitated the treatment of not only the kidney but also liver and other organs.

SDNTC spearheaded the expansion of dialysis services across Nepal. Initially, it provided its own resources to establish dialysis units in government hospitals in Janakpur and Dhangadhi. Subsequently, the centre assisted the government in procuring dialysis machines for nationwide distribution, playing a pivotal role in service expansion. Through comprehensive training programmes for over 1000 healthcare professionals, including doctors, nurses, and technicians, the centre facilitated the establishment of more than 90 dialysis centres throughout the country. Today, approximately 8,000 kidney failure patients receive regular dialysis, saving countless lives.

Another concerning issue arises from the evident gender discrimination observed in organ donation and transplantation. In the initial phase, when the first 99 kidney transplants were performed at the Bir Hospital, a striking gender disparity was noted: 90 per cent of donors were women, while 90 per cent of recipients were men, a level of inequality rarely seen elsewhere. To address this, the centre has implemented measures such as offering financial incentives to male donors and conducting public awareness campaigns emphasising gender equality in society.

Additionally, special provisions have been incorporated into our national Transplant Acts and Regulations, granting females an additional 3 points during organ allocation from brain-dead donors. These initiatives have indeed led to a reduction in gender discrimination in organ donation and transplantation. However, despite progressive laws and ongoing efforts for gender equality in women's health, disparities persist.

With 80 per cent of kidney transplant recipients being male and only 20 per cent female out of 1214 cases, and with 73 per cent of donors being female and only 27 per cent male, it begs the question: When will men and women truly have equal opportunities in practice? This issue warrants serious consideration from all relevant sectors.

Guided by the SDNTC, efforts are underway to extend kidney transplant services across all seven provinces of the nation. Initiatives led by the centre have already commenced kidney transplants in Pokhara (Gandaki Province) and Surkhet (Karnali Province). Additionally, plans are in motion for kidney transplant programmes in Dhangadhi (Sudur Paschim Province), Hetauda (Bagmati Province), Birgunj (Madhesh Province) and Biratnagar (Koshi Province).

In the twelve years since its founding, the centre has administered transplantation services to more than 1,200 individuals, achieving an outstanding success rate of 99 per cent. With an annual tally of 200 free-of-charge transplants, the centre solidifies its position as one of the foremost and most accomplished transplant facilities globally. The annual requirement for kidney transplants in Nepal is estimated to be around 3,000. While our centre handles 200 transplants annually, and other hospitals contribute roughly 100, totaling approximately 300 transplants per year, this underscores a significant gap between the demand and supply of kidney transplants.

In 2008, over 90 per cent of kidney failure patients faced fatal outcomes within months, but now, 98 per cent of kidney transplant recipients and 95 per cent of dialysis patients remain under the centre's care, indicating a significant improvement in kidney treatment in Nepal. Nevertheless, this service ought not to be confined solely to the centre but expanded across all seven provinces of the country. Such an extension would profoundly impact the lives of underprivileged Nepali individuals, potentially saving countless lives among our fellow citizens.

In order to accomplish this goal, the National Transplant Centre, operating under the Ministry of Health and Population necessitates adequate land and infrastructure. Furthermore, the establishment of a Transplant Health Science Academy is imperative to cultivate the requisite workforce capable of addressing the nation's demands.

Dr Shrestha is a kidney and liver transplant surgeon