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Organ donation in Nepal: Here’s everything you need to know including FAQs answered

The Chitwan Medical College Hospital conducted the first successful liver transplant operation on March 21, 2021.

Donating an organ is highly valued as it is gifting and saving the life of someone. A person can donate an organ after brain death to save the life of many patients with the failure of organs such as the liver, and kidney. To become an organ donor, all it takes is just the wish to donate an organ. Organ donation is a process whereby individuals agree to donate a healthy organ or tissue to a person with end-stage organ damage.

Every year, August 13 is celebrated as Word Organ Donation day with the objectives of raising awareness about the importance of organ donation and motivating people for donating organs after brain death. Therefore, on the occasion, we explain to you everything you need to know about the situation of organ donation in Nepal. In the last part of the post, we will also answer frequently asked questions and bust some common myths about organ donation.

Importance of organ donation in Nepal

Throughout the world, there is a huge gap between the demand and supply of organs. As per a report of traffic police in Nepal, thousands of road accidents kill hundreds of people every year. Many of such victims can be potential brain death organ donors. But, till now, only four brain death organ donations have been done in Nepal, with the first in 2017.

Although no official data exist on the number of kidney and liver failures in Nepal, it has been estimated that there are 3,000 kidney failure patients and 1,500 liver failure patients. The numbers increase every year. Most of them die without proper medical care and transplant. But, so far, only 13 live donor liver transplants have been done with the first case in 2016.

In developed countries like the USA, approximately 40,000 organ transplants are performed each year and 80 per cent of these organs come from deceased donors. The rate of organ donation in India is one of the lowest in the world at 0.86 per million as compared to 40 per million in Spain and more than 10 per million in most other developed nations.

The situation of organ donation is even worse in Nepal due to the lack of awareness and potential donors. Even after one is declared brain dead, there may be barriers to organ donation, such as religious beliefs, lack of awareness, lack of trust in the medical system, and a lack of training of healthcare workers.

As no religion prevents one from organ donation, it is high time that leaders from different religious groups came out in support of the cause of organ donation and educated their followers about the same. Also, as a step towards increasing organ donation, the patients’ relatives must be counselled about it inside the hospital itself as soon as intensivists and neurologists declare brain death.

So, there is an urgent need to start an organ donation awareness campaign for the general public so that the organ donation rate can improve in our country.

Representational image

Types of organ donation

There are two types of organ donation:

Live donation: A living person can donate only one kidney, some part of the liver or a part of the pancreas.

Donation after brain death: Brain death is a legal definition of death. It is the complete stopping of all brain functions that cannot be reversed. It means that because of extreme and serious trauma or injury to the brain, the body’s blood supply to the brain is blocked, and the brain dies. Brain death is death. It is permanent.

A brain-dead donor can donate both kidneys and lungs, heart, liver, intestine, pancreas and other tissues including heart valves, cornea, skin, bone/cartilage, and blood vessels to save the life of many people.

Criteria for organ donation in Nepal

Organ donation is done as per the Human Body Organ Transplant Act, 1998; its amendment in 2016; and its regulation issued in 2016. These laws cover all medico-legal aspects of organ/tissue transplantation. As per the act, the buying and selling of organs is a punishable offence with both fines and imprisonment.

Criteria for live liver donation

The donor should meet the following criteria:

  • Age: 18-50 years
  • Sex: Any sex
  • Matching blood group
  • Family members
  • No pregnancy
  • No evidence of any liver disease
  • Remnant volume in CT scan >30%
  • Liver attenuation index (CT scan) >+5
Criteria for live kidney and pancreas donation

The criteria for live kidney and pancreas donation in Nepal are quite complex. Doctors at transplantation centres can guide you about the process.

Criteria for organ donation after brain death

All people should consider themselves as possible organ donors after brain death irrespective of age, health and race. No individual is too old or too young to be a deceased donor.

Process of organ donation in Nepal (in case of brain death)

  • Declaration of the brain death
  • Information sent to the transplant coordination unit
  • A team of transplant coordinator, surgeons, anesthesiologists, nurses and other supportive staff mobilised
  • Transplant coordinators and doctors counselling the patient’s relative for organ donation and performing necessary investigation
  • A written consent taken from the family member
  • The donor taken to the operation theatre and the organ harvested
  • The donor’s body handed over to the donor family
  • Recipient counselling and organ allocation
  • Organ procurement, preservation and transport
  • Necessary documentation and organ transplantation
Image by Gerd Altmann from Pixabay

Some frequently asked questions

If brain death is confirmed, why does an individual’s heart continue beating?

As long as the heart has oxygen, it can continue to work. The ventilator provides enough oxygen to keep the heart beating for several hours. Without this artificial help, the heart would stop beating.

Does an individual feel any pain or suffering, after brain death is declared?

No. When someone is dead, there is no feeling of pain or suffering.

Is it possible that an individual in a coma is already brain-dead?

No. A patient in a coma continues to have brain activities and functions. When brain death occurs, all brain functions cease and there is no chance of recovery.

Does it cost money to donate my organ?

There is no cost to the donor family for the donation process. Once a patient is declared brain dead and the family has consented to donate organs, the billing is stopped.

Some myths busted

Myth: If I agree to donate, the hospital staff and doctors do not work hard to save my life.

Truth: The question of organ donation arises after brain death. Treating and transplant teams are always separate. You are seen by people with a moral and legal commitment to save your life first.

Myth: People can wake up from brain death.

Truth: Unlike coma patients, there is no possibility of recovery from brain death.

Myths: The donation disfigures the body and delays the funeral.

Truth: The donation of organs, tissues and eyes does not disfigure the body or change the way a person looks. They are removed surgically, as in a routine operation. Most donations take place within 24 hours after death, and therefore, they do not delay funeral arrangements.

Myth: My religion opposes donation.

Truth: All major religions including Christianity, Judaism, Hinduism, Islam, Buddhism support donation.

Myth: All I need to become an organ donor is to sign the donor card.

Truth: A person’s family must consent to donation at the time of their loved one’s death. If they do not, the donation does not happen regardless of any previous documentation. If you have made the decision for organ donation, it is important that you share your decision with your family.

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Dr Yadav is the chief liver transplant surgeon at the Chitwan Medical College.

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