The path to self-sufficiency in organ transplantation

WHO's report was largely accurate due to limited dialysis services, cost of around 50,000 per month and lack of kidney transplant services.

It has been 16 years since the kidney transplant service started in Nepal on a sustainable basis. In terms of health economics, kidney transplantation provides better outcomes and improves long-term quality of life than other treatments such as dialysis. Transplantation is unimaginable without organ donors. In Nepal, there is a system for transplants from healthy living people and brain dead people.

2,500 people die annually in Nepal due to road accidents. It is estimated that 1000 of them will be brain dead. It would be a great relief to the patients who were deprived of transplant without receiving organs, if the organs that are burnt or buried and wasted can be donated in time and transplanted to other people. Prime Minister Pushpa Kamal Dahal as well as some politicians, artists, journalists, social workers have announced for organ donation after brain death. But due to lack of public awareness about organ donation after brain death among the general public, this work has not been able to gain momentum.

A Challenging Start

Brain death, organ donation and transplantation had to face various challenges to come up with the concept. There were many people who raised questions about the possibility of brain death in Nepal, and for that, there were constant conversations with personalities from different fields, politicians, employees, artists, social workers, journalists and members of various organizations. Since the procedure for declaring brain death should be in the law, a separate committee had to be formed. As it would be appropriate for the Ministry of Health to take the lead for that, the then Health Secretary Praveen Mishra was requested. He immediately formed a 10-member committee under the coordination of Additional Health Secretary Tirtharaj Burlakoti to make a procedure for declaring brain death. Dr. in the

committee. Upendra Devkota, Dr. Pawan Sultania, Dr. Vasant Pant, Dr. JP Agrawal and Dr. DB Shah, Dr. Brahmadev Jha, Dr. Modnath Marhatta, Dr. Bhagwan Koirala and legal expert Indira Dahal. Since it would be a conflict of interests for a doctor who can perform a transplant to sit in the committee, it was decided to stay outside the committee and help. An in-depth study of the process of declaring brain death in America, Britain, Europe and Asia was done and presented to the working committee. After discussion in the committee, a procedure for declaring brain death suitable for Nepal was prepared.

It was found that it would be faster to amend and expand some of the letters in the Transplantation Act than to bring a separate law on brain death. The then Cabinet Chairman Khilraj Regmi, the then Ministers, Chief Secretary Leelamani Paudel and others were held for an interaction program on brain death. 3 international level workshops were held with famous transplant experts from UK, USA and India. The procedure was submitted to the Women, Child Development and Social Committee Chairman Ranju Jha's committee for approval. With the help of the then secretary Som Bahadur Thapa, the parliamentary committee continued to discuss and reached the parliament for approval. It was approved by Parliament in February 2016 without much hindrance. To include in the law, the team of rowers had to go to the parliament 50 times.

The then Law Secretary Komalshali Ghimire played an important role in making the declaration of brain death, organ donation and organ distribution regulations. It took 8 years to make its laws and regulations. Liver transplant was being prepared in December 2016, and for that, the regulations were also required to be amended. The regulations were made with the help of then Health Minister Gagan Thapa. Liver transplantation was started in Nepal. In April 2017, brain death was declared for the first time, with organ donation and two kidney transplants possible. After 8 years of continuous efforts, kidney and liver transplants have been done. It is possible to transplant various organs including heart, lungs, pancreas, small intestine. All 10 people who received kidney transplants from brain-dead people are living healthy lives.

What is brain death?

Brain death means the death of the brain stem. The term refers to a state of irreversible damage to the receptive (resistive) and responsive (responsive) activity of the brain. 8 lives can be saved from 1 brain dead person. There are 8 major organs that can be donated from a deceased person – two kidneys, two lungs, one liver, one heart, one pancreas and one small intestine. A senior physician and an anesthesiologist or intensivist can declare brain death only by examining the patient twice, 6 hours apart. For the purpose of ruling out brain death, a respiratory arrest test should be performed only after a preliminary medical examination and brain stem response have been performed.

The coordination unit of the brain death donation program is in the building of Shahid Dharmabhakta National Transplantation Center. This unit works independently in accordance with Nepal's Transplantation Act and Regulations. The unit has nothing to do with the management of the centre. In 2076/77, the head of the coordination unit was appointed by the Ministry of Health to a senior physician of the University Teaching Hospital. Senior Nephrologist and Head of Nephrology and Transplant Medicine Department of National Transplantation Center since 2078. Kalpanakumari is the best.

We receive a maximum of five to 10 calls about brain death every year. Managing a unit with separate staff leads to lack of workload and running a separate office without adequate workload leads to demotivation of staff and waste of resources. Brain death declaration, organ donation and transplantation activities are an emergency procedure. You will have to work 24 hours a day even on public holidays and festivals.

The center has full-time staff working on healthy living donor kidney and liver transplants. They are on call anytime from any hospital and are on round-the-clock duty to mobilize transplant manpower immediately as per requirement. This unit acts independently in organ donation, organ sharing and transplantation without any interest, inducement, pressure or influence. According to the criteria for transplantation, the organ is given to the person who gets the highest score to get a kidney or liver. The center has made arrangements to easily fill the organ donation form on its website and Facebook.

Transplantation situation

If you look at the world statistics, Spain is constantly at the forefront of organ donation and transplant rates. Then there are America, France, UK. The number of brain-dead donors in Asia has increased significantly over the past two decades. But it is low compared to western countries. In Asia, the number of brain dead organ donations increased from 25 in 2000 to 5,357 in 2019.

According to Transplantation Act 2072 and Regulation 2073, liver, kidney, brain death declaration, organ donation and transplantation have already been started in Nepal. Regulations have been made for heart transplants. About 2,500 people have registered to donate organs after death in the coordination unit of organ donation after brain death. So far, about 2,500 people have had kidney transplants and 43 people have had liver transplants in Nepal. Most of them were from healthy living donors, while a total of 10 kidney transplants and 3 liver transplants were done from brain-dead organs. Organ transplants from brain death account for only 1.3 percent of all transplants.

In case of brain death in a hospital, the concerned hospital must inform the coordination unit for any possibility of organ donation and transplantation after brain death. Although it is estimated that there are about 1000 brain deaths in the country every year, the most important question in the current situation is why no information about brain death has come from the big hospitals in Kathmandu Valley.

In Nepal, the disparity between male and female donors continues to be discussed in terms of organ donation and transplantation. Recent data has revealed an interesting fact on this matter. So far, 9 out of 10 recipients of kidney transplants from five brain dead donors in Nepal were male and only one female (10 percent) recipient, while 4 (80 percent) of brain dead donors were male and 1 (20 percent) female. While 1,228 kidney transplants have been done at the center so far, 72 percent of the healthy living organ donors are women and 28 percent are men. Organ donors are over-represented by women and organ recipients are over-represented by men. To reduce this disparity, female members on the waiting list for kidney transplants from brain dead persons are given three times more points, i.e. 3 points, while men are given only 1 point.

After the brain death of a patient, when the family of the deceased is informed that his organs can save someone else, it has become a challenge for the coordination unit. It is not as easy as you think to get the family who is suffering from the loss of their loved one to agree to organ donation.

A 24-year-old man from Sindhuli, who suffered a serious head injury after falling from a jeep, died of brain death after the treatment was unsuccessful. It was hard to explain to the families of patients who were leading a normal life about organ donation after brain death. Through a social worker from Sindhuli, the family agreed to donate the organ only after 8 hours of effort. According to Nepal's transplant law, we reached the hospital with the team to perform the operation at 12:00 pm after declaring brain death and completing the entire procedure for transplant. After removing 2 kidneys at around 4 in the morning, we returned to the transplant center Bhaktapur. In another case, a patient who was preparing for a liver transplant for her daughter was advised to receive it from a brain-dead donor but refused.

2074 On 28 May 2074, kidney transplant was successfully completed for 15 and 51-year-old patients who were on the active list after completing the entire procedure for organ procurement after brain death. They are safe to this day. Similarly, the family of a 72-year-old brain-dead patient in a hospital in Lalitpur felt somewhat at ease compared to the first as they were already aware of the matter.

Recently there was news of brain death from a senior anesthesiologist and intensive care specialist of a hospital in Lalitpur. On getting the news, the co-ordination unit staff immediately rushed to the hospital and after 7 hours of consultation, the nieces of the deceased agreed to donate their organs. However, after his wife's rejection, he could not donate the organ from the deceased. Therefore, it is necessary to spread public awareness about organ donation after brain death.

During these 7 years, we have received information about brain death from about 45 different hospitals. While consulting with the family of the patient, there are also cases where the heart of the brain dead person is stopped during the 12 to 15 hour waiting period for relatives coming from abroad. In some cases, the patient's family agrees, but there is also the bitter experience of being rejected by the hospital management and having to return empty-handed.

Transplant promotion efforts

The most important thing is to increase public awareness. Under the leadership of the center, we have conducted various organ donation walks, camps, sports, interaction programs, workshops, conferences. Although there is a provision in the law that the coordination unit must be informed in case of brain death, most of the hospitals do not know about it, so the unit has been attending various hospitals every Monday and communicating about brain death.

It would be effective if a chapter on organ donation and transplantation could be included in the 9th or 10th grade health education curriculum. There is a situation where the process for creating the curriculum has been advanced. A provision for organ donation is kept in the application for driver's license abroad. We have not discussed with various transport ministers, but they have expressed that it will be possible only by making a law, so extensive preparations will have to be made. The program can be strengthened as a provision of facilities, relief, treatment costs, insurance, etc., which is killed by death. The center has arranged a lakh's family to donate 50,000 and the organs, which may be low. Hence, the program that the effects of some members of the family could have been able to bring part of some members of the family. Similarly, the issue of assisting children from giving scholarships or other kinds of kinds.

conclusions & nbsp;

in 2008 and killing the history of Dablo's chronic report in 2008, the center has made up 1,288 Kigala transfers. A 98 percent active life is living in dialis, and 95 percent illness. In 12 years of establishing Center, it is a matter of pride to Nepali Nepali.

can expand the implantation center in all the provinces, while the kidney fails can become a happy news for the failed person. With active support from all sectors, 80 percent of transplants will be possible in Nepal through organ donation after brain death, just like in other countries. Lack of limbs will end the situation where any Nepali will not be without implanting. And, Nepal may be self-sufficient. & Nbsp;

- Shrestha-Martyri-Mercury National Transplanted National Transplant Khayantapur of Bhaktapur are surgeons surgeons.