Medicosnext
Dr. Pukar Chandra Shrestha is Executive Director of Human Organ Transplant Centre, Nepal. He has been credited with establishing the institution as the most successful kidney transplant centre in Nepal. Dr. Shrestha returned to Nepal after completing MRCS from Royal College of Edinburgh, UK, to start a transplant program at Bir Hospital, and played an instrumental role in formulating new laws to facilitate organ transplant in Nepal.
Lets start with the history of organ transplant in Nepal.
Solid organ transplant’ started in Nepal 1998 when two private hospitals, Everest Nursing Home and Dans Care, carried out kidney transplants informally. The transplants were carried out off the record, as we did not have legislation to do such surgeries in Nepal. Then, in 2004, a transplant was carried out at Bir Hospital, but the service did not continue. In 2008, a transplant was carried out at Teaching Hospital, and at Bir Hospital again, after a few months.
On the legal front, the human organ transplant act came into force in 2055, it was later amended in 2058. But we realized that the provisions in the act were hampering the growth of organ transplants in Nepal. According to the act, only a limited number of family members could donate organs to patients in need of transplants. Because of this, thousands of Nepalis had to go abroad to get transplants.
Then, in 2072, parliament passed a new piece of legislation that removed restrictions on who could donate organs. The new law said that anyone who is a relative of the person in need of a transplant could do so. It took us eight years to convince the lawmakers about this.
What were your initial days in Nepal like after returning from the UK?
Then health minister, Giriraj Mani Pokhrel, called me to his office and asked me if I would be interested in starting a transplant unit at Bir Hospital. I agreed. But we faced a lot of challenges at Bir. For example, we did not have a dedicated operation theater. We had limited resources, and the doctors there did there bit to help us. The government then gave us a building in Bhaktapur to start the Human Organ Transplant Centre. Things moved pretty fast. We now have a 100-bed capacity facility.
Could you give us some numbers on kidney transplants in Nepal?
We carry out around 200 transplants at our center, Teaching Hospital does around 130-135 a year, and Bir around 14 a year. According to records, around 1,500 people have received kidney transplants in Nepal, so far. If you are to look at our record, we have carried out 435 successful transplants from 2073. We have a 100 percent success record as far a patient recovery and discharge is concerned.
If you look at liver transplants, it’s a bit complicated. We carried out the first liver transplant in 2073. Transplanting liver from a live donor is a bit more complicated, and we are not there yet. But, we can transplant liver from a brain-dead person.
Despite the great results, why do you think so many people go abroad for transplants?
What we have achieved at our center is astounding. Ever since we started our service, we have a 99 percent success rate for the 6.5 years we have been in operation. I think this success rate would be an envy for any institution in any country.
What is the main challenge your center faces?
Transplanting organs from a brain-dead person is easier than from live donors. In Nepal, around 3,000 people need kidney transplant every year. But, not even a tiny fraction of them receive organs from brain-dead people. It is believed that around 1,000 brain death cases occur in the Kathmandu valley every year, but almost no one wants to donate their loved ones’ organs. Ever since we started transplants, we have only received 20 calls, and out of that we have only done six kidney transplants and three liver transplants. We have technically proven that we can transplant organs, but talking to people during a time of grief is not easy.
Are you taking any steps to address this challenge?
I always say that brain-dead transplant ads should be like that of Coke. We need to have such ads placed on every nook and corner. That is why we are working with the government to campaign for organ donation. Only recently, we worked with MaHa Jodi to prepare a documentary on the issue. We are planning to invite all mayors, deputy mayors, and ward chairs of Kathmandu Valley to watch the documentary. We hope this will help in raising awareness about the issue.
What about the challenges facing the center?
Well, we carry out the most number of transplants in Nepal, but we are yet to receive academic recognition. We would like to run postgraduate courses on transplantation. That would help us train new doctors. Also, we have asked the government to allow us to set up transplant centers in all provinces. That is yet to materialize. The other thing is that we want to expand the center to accommodate at least 300 beds. We hope the government takes steps towards this direction soon.
