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

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

3 Status of Kidney failureEstimated 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

4 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

5 History of Organ Transplantation in NepalRenal 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

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

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

8 Haemodialysis machines 40CRRT

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

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13 Our Transplant (HOTC/ Bir) ResultsDec – 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 % Diabetes mellitus % Alport’s syndrome % Unknown % 13

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

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

17 Relationship

18 Aarogya Foundation: “not for profit”organisation

19 Lab facility for transplantation: HLA

20 Taccrolimus level monitoring

21 Awareness campaigns

22 1st Transplant Game in NepalFinal Score 3:0 Won by transplantees 100m race

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24 6th Nepal Transplang Games 2072

25 Working with Govt. policyFinancial 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

26 Brain Death Donor TransplantationAbout 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

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

31 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

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

33 Thank You