Organ Failure in Nepal: Rapidly Growing Challenge for All Dr. Pukar Shrestha, Executive Director and Transplant Surgeon Human Organ Transplant Center (HOTC)

Status of Organ failures in Nepal Estimated figure - 3000 Renal failure / yr 1000 Liver failures / yr 3 millions diabetics No data on heart or lung failures

Status of Kidney failure Estimated worldwide dialysis population > estimated figure was 2 million by 2010 3000 patients develop renal failure every year in Nepal Only 10% of kidney failure patients might reach dialysis 90% of kidney failure patients die within few months in South Asia Worse in Africa

Challenges Policy issues 2. Lack of awareness: Donors from close relatives only Cadaveric transplantation not started 2. Lack of awareness: Lack of regular check up Organ trafficking Going for illegal and expensive transplantation abroad Economic Issues Nepal losing about Rs. 6 billion yearly 4. Gender issues 5. Limited infrastructures

History of Organ Transplantation in Nepal Renal transplants carried out in a private hospital in Nepal on 1997, Formal renal transplant was done on 2004 at Bir hospital. Service resume on 2008 at two centers of Nepal- TUTH and Bir Hospital. Cornea Transplant Bone marrow transplant

Who should solve this problem? Government Non Governmental organizations Private Organizations International organizations

Human Organ Transplant Center: Estd Human Organ Transplant Center: Estd. in 2012 : New Hope for Organ failure patients !

Haemodialysis machines 40 CRRT 1

HOTC : Dialysis & Transplant Service Cheapest Haemo/Peritoneal from Nov. 2012 Free for underprivileged Charge Rs. 1250 ($ 12) / session for all CRRT: 1. Resistant rejections 2. Critically ill patients Renal Transplant cost : $3000-4000

Our Transplant (HOTC/ Bir) Results Dec. 2008 – Jan 2014 (5 yrs) 179 live donor renal transplants (HOTC 80, Bir 99) All recipients were males except 20 Females Age ranged from 15 to 66 yrs, mean 37yrs. Primary diseases of recipients – Chronic Glomerulo-nephropathy / Hypertensive 52% Obstructive uropathy 12% Diabetes mellitus 8% Alport’s syndrome 4% Unknown 24% 13

Outcome of Renal Transplantation All grafts had immediate function 99% patients discharged after operation Delayed graft function: 5% 10-50% (world) Rejection rate : 11%. 20% (world) (8/10bx+) Surgical site infection : 2.0 % 2-25% 14

Gender Bias Recipients : M 87% vs F 13% Donors: M 24% vs F 76% 16

Relationship

Aarogya Foundation: “not for profit”organisation

Lab facility for transplantation: HLA

Taccrolimus level monitoring

Awareness campaigns

1st Transplant Game in Nepal Final Score 3:0 Won by transplantees 100m race

6th Nepal Transplang Games 2072 http://aarogyafoundation.org.np/wp-content/uploads/2015/06/RAJ_7107-1024x680.jpg

Working with Govt. policy Financial support: Free dialysis for marginalized people for 2 year Grant for Renal Transplant: US$ 2000 Grant for Post Tx medications: US$ 1000 Expanding Haemodiaysis services across the country Expansion of Live donor pool & Initiate Deceased donor transplants Bringing regulations for Liver transplant

Brain Death Donor Transplantation About 1000 brain deaths / yr in Nepal At least 8 major organs from ‘brain dead’ donor – 2 kidneys, 2 lungs, 1 liver, 1 Heart, 1 Pancreas, 1 small intestine 80% Transplants from such donors in developed country Brain Death Criteria for Nepal: already formulated Draft waiting for approval from govt. HOTC ready to start brain death donor transplant

Joint effort of HOTC & Aarogya To address Gender Biasness Financial support When Male donates organ to Female 50% of the service charge for Tx in HOTC

Conclusion Renal Transplantation in Nepal is now well established service with ‘world class’ result possibly at the cheapest price. A lot to be done to meet the transplant demand Cost of post transplant medications & Employment Brain Death Donor Transplantation Multi-organ transplant e.g Liver transplant is our next dream Newer techniques & medications

Prevention is better than cure Control your diabetes and blood pressure Control body weight Balanced diet Regular Exercise Take plenty of fluid No tobacco and alcohol Regular health check up

Thank You