Kidney Transplant in Nepal

In the functioning of a human body every organ, both internal and external, irrespective of its size, plays a vital role in its own aspect. While people often tend to take care of the external organs of their body, the internal organs are seldom thought about. The negligence in caring for these internal organs can lead to the deterioration of the overall health of a person. One such vital internal organ of the body, the slightest problem in which can create the worst impact on the whole body is the kidney.

The kidneys, a pair of bean-shaped organs that sit at either side of the spine and back of the abdomen, play the vital role of filtration in the human body where they filter all the toxins and waste products from the blood and discard them from the body in the form of urine. Kidneys play an important role in balancing the perfect level of fluids in the body and they also produce a specific type of hormone to regulate the blood pressure levels within the body. Apart from that, kidneys also control the production of red blood cells and produce an active form of vitamin D to maintain the health and strength of bones.

Symptoms and causes of unhealthy kidneys

In the case where the kidneys are no longer in a healthy condition, the effects will be shown throughout one’s body. The following are the most prevalent symptoms of kidney diseases:

• Excessive fatigue or feeling tired with very little effort
• Feeling cold at times when others are in a normal or warm temperature
• Swollen feet and ankles, constant puffiness around the eyes
• Frequent urge for urination, foamy urine or blood in the urine
• Constant itchiness, dryness and irritation of the skin
• Feeling nauseous, losing appetite and smelly breath

These are the most common symptoms of kidney diseases. These symptoms can be caused when there are several issues with the kidneys. Some of which might be:

• Diabetes and high blood pressure can damage the health of kidneys over time
• A group of diseases called Glomerulonephritis which causes inflammation in the kidney
• Genetic diseases like polycystic kidney disease, in which large cysts can damage the kidney tissue
• Autoimmune diseases like Lupus nephritis make the body’s defence system work against itself and cause inflammation in the kidney
• Kidney and urinary tract defects existing before birth

These are some of the most common diseases and conditions that worsen the health of kidneys.

Common treatments for kidney diseases Nepal

In the early stages of kidney disease, when a person visits the doctor, the condition of their kidneys are determined through a series of blood test, urine tests, glomerular filtration rate (GFR) test, serum creatinine level test, CT scans, MRIs etc. After the cause and stage of the disease is determined, it is commonly treated with medications, maintaining one’s blood pressure and glucose levels, following a suitable diet and regular doctor visits and checkups. In the later stages of the disease, when the kidneys are no longer properly functioning, the health care provider will suggest the option of dialysis by which the waste product and toxic elements from the kidney using external machines and solutions. There are essentially two types of kidney dialysis, which are:

• Hemodialysis in which a machine is used to purify the blood of a patient’s body and then return the purified blood free of waste, excess salt and excess water back to the kidneys. A person with end-stage kidney disease needs to go through four hours of hemodialysis, three times a week in order to increase their life expectancy.
• Peritoneal dialysis involves a special dialysis solution which is directly placed in the patient’s abdomen through a catheter to soak up the waste and toxins from the blood and then the solution exits the body using the same catheter. This dialysis can be of two types; the first being continuous ambulatory peritoneal dialysis (CAPD), in which the dialysis solution is changed four times a day and continuous cycling peritoneal dialysis (CCPD), in which a machine automatically changes the solution throughout the night.

Kidney dialysis is done for patients with end-stage kidney diseases. But in cases where dialysis is not a viable option anymore, the doctor might suggest a kidney transplant.

What is a kidney transplant:

The procedure of a kidney transplant involves the removal of the unhealthy kidney from the patient’s body and replacing it with a healthy kidney received from a donor. The most common types of kidney transplants can be living donor kidney transplant and deceased donor kidney transplant. There are several distinctions in types of living donor kidney transplants.

Living Donor Kidney Transplant in Nepal

A living donor kidney transplant is a procedure in which one healthy kidney taken from a willing living donor is placed in the body of an end-stage kidney disease patient. The requirements for being a living kidney donor are as follows:

• The donor must be between the age of 18 to 60 years
• The donor must have proper kidney function
• The donor must not have underlying health conditions related to heart, blood pressure or diabetes
• The donor should be in optimal physical and mental health condition

These are some of the major criteria for being qualified as a living kidney donor but in cases where the donor doesn’t fall into the age criteria or might have had a history of health conditions, they might be required to complete a few more criteria for being eligible. Based on all the criteria, there can be the following types of living donor kidney transplants:

• Related living donor kidney transplant: In this type of kidney transplant, the close relative of the patient; a parent, sibling, children over the age of 18 or any other blood relatives who are found to be a match can donate one of their healthy kidneys to the patient.
• Non-related living donor kidney transplant: In this type of kidney transplant, people who are not related to the patient by blood but are emotionally close to them can serve as a donor if they are found to be a match. In this case, the patient can receive a kidney from either their spouse, friends, in-laws, neighbours, or close acquaintances.
• Paired living donor kidney transplant: In the cases where a pair of living donor and recipient are not found to be a good match due to issues with match in immunology or any such issues; a matching pair of donor and recipient who are facing the same issue can be mutually exchanged to ensure a more successful kidney transplant surgery.
• Altruistic living donor kidney transplant: In this case, the willing donor commits to donating his healthy kidney to anyone on the organ waiting list anonymously. In this case, the donor and the recipient don’t know each other to any degree.

Living donor kidney transplants constitute the majority of kidney transplant procedures in Nepal and a high percentage of living donor kidney transplants consists of kidneys received from relatives. On average, the living donor kidney transplant procedure in Nepal can cost around 22,000 USD.

Deceased donor kidney transplant in Nepal

In a deceased donor kidney transplant or cadaveric donor kidney transplant procedure, a patient suffering from end-stage kidney disease or kidney failure receives a healthy kidney from a deceased donor. In this type of kidney transplantation, the patient is put on an organ donation waiting list as after the death of the willing donor they can receive a healthy organ based on their number on the list. The waiting period for receiving a kidney through a deceased donor can be long and can take up to a few years. There can be a few types of deceased donor kidney transplants, which are as follows:

Standard Criteria Deceased donor kidney transplant: In this case, healthy kidneys are received from donors between the age of 18-60 years who were in good health and met with the other criteria for kidney donation. The received kidneys are usually assigned to two different patients who are found to be a match with the donor.

Expanded Criteria Deceased donor kidney transplant: In this case, organs are received from donors who are above the age of 60 years or who might have had conditions like high blood pressure. These organs are assigned to recipients based on their condition, age and life expectancy.

Post Cardiac death deceased donor kidney transplant: In this case, the organs are received from a donor when there’s a sudden death due to cardiac arrest or in the case of patients where the doctors believe the continuation of medical care to be futile. In such cases, the medical treatments are stopped and the organs are retrieved instead while they are still in good condition.

Double kidney transplant: In the cases of expanded criteria deceased donor, where the donor is at the higher end of the criteria limit, both of the donor’s kidneys are used for just one patient for better chances of success.

The amount of deceased donor kidney transplants is far lesser compared to the number of living donor kidney transplants in Nepal. The procedure and other costs for a deceased donor kidney transplant in Nepal can cost anywhere around 20,000 USD.

Paediatric kidney transplant in Nepal:

A paediatric kidney transplant is a procedure in which the damaged or improperly functioning kidney is taken out from a child or minor’s body and replaced by a healthy kidney received from a donor. A kidney transplant might be required in a paediatric patient if they are suffering from the following conditions:

• Genetically inherited diseases and congenital disabilities that can lead to kidney failure in children from birth to age four.
• Nephrotic diseases and hereditary disorders that can lead to renal failure.
• Autoimmune diseases like lupus which can damage the kidneys and renal system.
• Specific health conditions that affect the blood vessels in renal tubes.

These are the most common causes that can cause kidney and renal failure in children. In cases where the condition has reached its end stage or the patient is on the verge of complete kidney failure, the paediatric nephrologist consultant might recommend kidney transplantation as the final solution. In most cases of paediatric kidney transplantation, the patient receives the organ through a living donor kidney transplant and the donor is usually a parent or close relative of the patient. But in the case where a proper match for the patient’s kidney is not found with related living donors, the patient is put on the organ donation list in order to receive a kidney transplant from a deceased donor. In order to receive a healthy organ from a deceased donor for a paediatric patient, the following criteria are taken into consideration:

• The age of the paediatric patient
• Blood and immune match of the donor and the recipient
• The size of the donor’s kidney compared to the patient’s kidney
• The urgency of the patient’s condition
• The amount of time the patient has spent on the organ waiting list
• The distance between the donor’s and the patient’s hospital

Based on these factors, the patient is assigned a kidney when the time comes. On average, it costs around 24,000 USD to perform a paediatric kidney transplant in Nepal.

Kidney transplant in Nepal

Though it was started as late as in the year 2008, the kidney transplant program in Nepal has established its success in the medical field throughout the world by performing hundreds of successful kidney transplant surgeries within a short duration. With the availability of experienced surgeons at affordable costs for surgeries while compared to other countries, Nepal has now presented itself as a viable option for patients looking for a kidney transplant from within the country and beyond. The reasons for choosing Nepal as the centre for Kidney transplant procedure can be as follows:

The cost of Kidney transplant in Nepal:

Just like any other surgical procedure, the overall cost of a kidney transplant is not based on just the cost of the procedure itself but on the number and types of tests done before, during and after the procedure, medications, the preferred medical institution and the facilities provided by them for pre, during and post-surgical care, as well as the expenses for travelling etc borne by the patient. In a regular kidney transplantation surgery, the cost of the procedure can also vary based on the type of transplant procedure availed by the patient. If the patient has undergone a deceased donor transplant or a living donor transplant, the distance from the donor’s hospital to the patient’s location can add some extra cost to the overall procedure while in the living donor transplant, the cost can vary based on if the donor was a known person or unknown and their pre and post-operative care also add to the overall cost. Based on all these important points, the average cost of kidney transplantation varies drastically from one country to another.

The average cost of a kidney transplant procedure in Nepal is estimated at around 20-24000 USD based on the important factors that are most likely to impact the cost of any surgery. This average cost can vary based on the patient’s choice of healthcare provider and extra care elements, whereas the same procedure can cost up to 50,000 USD if it is done in India. Nepal is a significantly more affordable alternative for receiving the operation when compared to other countries because of the hefty cost that the process may require there.

Cost of kidney transplant in major cities of Nepal:

A kidney transplant procedure’s cost is influenced by both the type of kidney transplant and the area in which it is carried out. The key cost-affecting variables of the surgery, including as the accessibility of seasoned specialists and the amenities offered by the hospital, among many others, can be influenced by the site of the transplant surgery. These are the reasons why the price of a kidney transplant in Nepal can differ from one city to the next:

Bhaktapur offers a more affordable choice for kidney transplant procedures in Nepal because it is home to some of the best and most reputable medical institutions in the public and private sectors. Kathmandu is also a prime location for carrying out kidney transplant procedures in Nepal. The existence of multiple high-end medical institutions and seasoned doctors of the field, makes Kathmandu a desirable location for availing the kidney transplant surgery. In the more recent, due to the rise of successfully carried out procedures in top hospitals like KIST, Lalitpur has also come into view as a good option for availing transplant surgery, but the developing situation of the location might make it a bit more expensive than usual.

Best Hospitals for Kidney transplant in Nepal:

It is crucial to check at the availability of reputable hospitals when choosing a location for a challenging procedure like a kidney transplant. In terms of kidney transplantation, Nepal boasts some of the best medical facilities in the world. The following are a few of the top medical facilities offering kidney transplant surgery:

Shahid Dharmabhakta National Transplant Center (SDNTC) Kathmandu, Nepal:

One of the most well-known organisations in medicine that has worked in the area of organ transplantation is the SDNTC. The SDNTC has a distinguished reputation among successful medical facilities being the first medical facility in Nepal to successfully complete a kidney transplant procedure.

At: Bhaktapur 44800, Nepal

Tribhuvan University Teaching Hospital, Mahargunj (TUTH) Kathmandu Nepal:

TUTH is one of the most reputed medical institutions in Nepal which is operated by the government of Nepal. Among various other facilities, the teaching hospital hosts number of experienced professionals in the field of kidney diseases.

At: Maharajgunj Rd, Kathmandu 44600, Nepal

The National Kidney Center, Nepal:

The National Kidney Center of Nepal has successfully catered to patients looking for getting kidney transplant surgery. With a team of expert surgeons with years of experience in the field, the National Kidney Center is one of the best options for availing kidney transplant in Nepal.

At: Bhairab Bhawan, Ring Rd, Kathmandu 44600, Nepal

Bir Hospital, Mahabouddh, Kathmandu, Nepal:

The Bir Hospital is among the oldest and most reputed medical facilities in Nepal which has a well-established department for the treatment of kidney diseases.

At: Kanti Path, Kathmandu 44600, Nepal

Norvic International Hospital, Kathmandu, Nepal:

The Norvic International Hospital has well-equipped machinery and testing facilities in all departments of the hospital and hosts some of the most talented surgeons in the country which makes it a viable option for availing the surgery.

At: Kathmandu 44617, Nepal

KIST Medical College Teaching Hospital:

The KIST medical college and Teaching Hospital has established its reputation as one of the best and reliable options for availing kidney transplant in Nepal by successfully performing numerous transplant procedures.

At: KIST Hospital Road, Lalitpur, 44700, Nepal

These well-established medical institutions and hospitals in Nepal have supreme facilities and post and pre-op care for patients looking to get a kidney transplant operation.

Top Surgeons for Kidney Transplant in Nepal

Teams of qualified surgeons and medical experts undertake kidney transplants in Nepal, and some of the biggest names in transplant surgery are among them. These doctors have years of experience treating kidney disorders and nephrology and have successfully completed kidney transplant surgery throughout their careers. The following are a few of Nepal’s top kidney transplant surgeons:

Dr Sumit Acharya, MBBS: Dr Acharya is a reputed neurologist of the region with a speciality in kidney disease and transplant with over a decade of experience in the medical field. Dr Acharya is a nephrology consultant at SDNTC.

Dr Anil Pokhrel, MBBS, MD, DM: Dr Pokhrel is a senior nephrology consultant at Kathmandu Medical College Teaching Hospital. Dr Pokhrel is an expert in kidney diseases and transplant with over 12 years of experience.

Dr Neeraj Singh, MBBS, MD, DM: Dr Singh is an experienced nephrologist working from his own clinic in Lalitpur. Dr Singh is a reputed transplant surgeon and has been a nephrology consultant at Vayodha Hospital.

Dr Rishi K Kafle, MD, FASN: Dr Kafle is an experienced surgeon in the field of kidney transplant procedure. He is a senior consultant at the National Kidney Centre, Nepal and is well-known among patients.

The leading hospitals and medical institutions have fully equipped nephrology and transplant departments which are decked with experienced surgeons. The team of kidney transplant surgeons available in Nepal have garnered international attention because of their high success rates while performing the surgery.

Risks and Success Rates of Kidney Transplant in Nepal

When considering surgery, it’s important to understand that kidney transplant surgery is a complex procedure, difficult to perform, and comes with a certain degree of risk.

Risks of kidney transplant in Nepal:

The risks generally involved with kidney transplantation procedure are:

• The recipient’s body rejecting the donor’s kidney
• Internal bleeding or haemorrhage
• Blood clots and increased risk of infections
• Improper functioning of the new kidney in the first few hours
• Problems with blood flow and urinary function

These are the typical dangers connected to kidney transplant procedures. In the weeks following the treatment, patients are closely watched in the hospital in order to manage these risks and problems.

The success rate of kidney transplants in Nepal

Patients who are on the verge of kidney failure or are in the end-stage of kidney diseases have very short life expectancies. In such conditions, availing of the transplant can increase their chances to a much higher percentage. In a living donor kidney transplant, the recipient has a high success rate of 97% for surviving past 1 year after the surgery. There’s an 86% chance of life expectancy past five years in a living donor kidney transplant. In the case of deceased donor kidney transplant, the survival rate of patients after 1 year is 96%, whereas the life expectancy after 5 years is up to 79%. On average, the survival rate of end-stage kidney disease patients is much higher if they avail a kidney transplant surgery.

Insurance coverage for Kidney Transplant in Nepal

Any form of surgical operation can be very expensive, but kidney transplant surgery is particularly intricate and important, therefore the price tag might increase significantly. The following items are typically on the kidney transplant expenditure list:
Pre-operative examinations and screenings: These comprise the many examinations, screenings, and checks carried out on the patient to ascertain the health of their organs.

• Pre-operative care: The majority of the time, patients are admitted to hospitals to receive pre-operative care that is intended to get them ready for surgery.
• Hospitalisation expenses: These cover the price of nursing services, attendants, room rent, and other hospital fees.
• Transplantation surgery costs: These cover the price of the entire procedure, any necessary medications, as well as the salaries of the surgeon’s team of doctors.
• Post-operative care for the donor (in the case of a living donor transplant): In the event of a living donor transplant, the recipient is often responsible for paying for the donor’s post-operative care, medications, and hospitalisation expenses.
• Post-surgery treatment and recovery: This covers the recipient’s hospitalisation bills as well as any post-surgery exams, prescriptions, and screenings.

The insurance coverage can vary greatly depending on the patient’s choice of hospital for surgery and the type of medical insurance they have selected. Additionally, there are specialised health insurance plans that can assist patients in covering the majority of the transplantation costs.

Top insurance companies for kidney transplants in Nepal

Not all insurance companies and their policies are created equal. So, when looking for a policy covering the cost of a critical procedure like organ transplantation, a person needs to check for insurance companies that provide specific policies meant for providing support during such complex procedures. The following are some of the top insurance companies in Nepal that provide a wide range of health and general insurance policies:

Nepal Life insurance company: One of the major insurance providers in Nepal, The Nepal Life Insurance Company was founded by private investors and offers plans like the Critical Illness Rider, which covers expensive and life-saving procedures like kidney transplants.

Rastriya Beema Sansthan, Nepal: There are numerous types of health and life insurance policies offered by this one and only government-owned insurance organisation in Nepal.

National Life Insurance Company Limited: This company, which was created in 1988 and is one of the largest privately owned life insurance companies in Nepal, has a wide network of branches and agents.

Life Insurance Corporation Nepal Limited: This is the Life Insurance Corporation of India subsidiary that was founded in Nepal in 2000. This business has flourished to become one of Nepal’s most well-known insurance providers thanks to its superior plans and offerings.

Metlife Nepal: Metlife Nepal, also known as American Life Insurance Company Limited, was founded in 2001 and has won the faith of the Nepalese people thanks to its well-known reputation, superior services, and reachable branches.

Gurans Life Insurance Company: Founded in Nepal in 2018, this privately owned insurance company. They have succeeded in making a name for themselves as one of the top insurance providers in Nepal thanks to their reasonable insurance plans and a variety of profitable products.

One can find appropriate health insurance plans and packages that give coverage for a necessary surgical treatment like a kidney transplant by looking through the services offered by reputable insurance firms.

Developments in the field of kidney transplant in Nepal

Ever since the journey of kidney transplant surgery was started in Nepal in 2008, the country has not stopped for a moment to look back. There have been over 1,000 kidney transplants done at SDNTC alone and many more at various other medical facilities. The Nepalese government has been trying its best to provide the best renal care for their citizens and the success of transplant surgeries in the country is a shred of visible evidence for that. Although most of the kidney transplants are taken from living donor transplants, the country has taken the initiative to raise awareness on organ donation in order to ensure that more patients can avail the surgery when required.

What to expect Post-kidney transplant in Nepal

It The patient who received a kidney transplant has to remain in the hospital for several weeks after the surgery. This is an important step after the procedure because at this stage doctors and medical staff continuously monitor the patient to make sure the transplanted organ fits snugly into the recipient’s body and that there are no other complications. In the case of a transplant from a living donor, both the donor and the recipient should update their follow-up tests and screenings after the procedure to maintain healing. By taking the appropriate medications and maintaining a healthy lifestyle and diet by avoiding alcohol and smoking, kidney transplant patients can return to a normal lifestyle with an acceptable quality of life according to their needs. time and patience.

Reviews of kidney transplant surgery in Nepal:

The kidney transplant program was started in Nepal back in 2008, and since then thousands of successful kidney transplant procedures have been completed in the country at different hospitals and locations. The country has seen great success rates with a smaller number of complications with each procedure.

Getting kidney transplant surgery in the nation has become a highly reliable alternative thanks to the availability of skilled transplant surgeons and the knowledge of medical professionals from other nations. Another factor that makes Nepal an attractive site for receiving the operation is the procedure’s low cost. Individuals have regarded the hospital facilities to be adequate, and they have also expressed their appreciation for the post-op monitoring and care.

The expertise of experienced transplant surgeons and the competitive pricing of the surgeries has made Nepal a choice destination for kidney transplant for patients from overseas as well. Overall, getting kidney transplant surgery in Nepal has been considered as a favourable option based on economic sustenance and expertise in service, by people who have availed the surgery in the country.

This is why, after talking with the consulting physician and taking into account the patient’s condition, the availability of the donor organ, and other factors, Nepal can be selected as a good alternative as the location for the kidney transplant procedure.