You, dear reader, wake up in a hospital bed and the South-Indian doctors who are probably speaking Tamil or Malayalam assure you that you are completely fine. Soon, you realize the remnants of a gash at your belly side. In the next few weeks you have trouble urinating, you feel abdominal pain and a lot of other discomforts. After an appointment with another doctor, you are told that one of your kidneys are missing. But you remember that charming stranger who had given money to you along with the promise and assurance that ‘they grow back.’ ‘Kidneys don’t grow back’ says your doctor. Not only that, you realize that you were paid less than one percent of what kidneys cost (about $250,000 in the U.S. black market) and the ‘organ broker’ is long, long gone. Unfortunately, not only is he gone with your kidney but with the kidneys of several others like you, probably from a village like Hokse, known as kidney valley.
Hundreds of kidneys are trafficked every day across the border to fill a gaping supply and itchy pockets. Kidney problems and organ transplantations have always been mired in unfavorable governmental laws, ill-equipped facilities and a lack of wherewithal to sufficiently deal with illegal trade. However, it’s not the disease itself that poses the main problem, it is the egregiously exorbitant expense. Outside of SAARC the cost of dialysis per week is about $600 to $700. In Nepal, it is less than a quarter of that. Despite this financial advantage, the fact remains that the vast majority of Nepalese people are just so incredibly impoverished so as to be unable to afford dialysis sessions, let alone organ transplant.
Regular hemodialysis costs from around $100 per month in the Human Organ Transplant Centre to around $250 dollars in private sectors – including all secondary costs. In a country, whose average family consumption is a mere $150 per month (2010 Census), the inability to afford such services is an unequivocal death sentence for the poor and a life sentence for the slightly better off for whom their time won’t run out until their money doesn’t run out – as chronic kidney disease is, as of this date, incurable and dialysis is required for life without the provision of kidney transplantation.
Our laws have certainly come a long way in the field of organ transplantation. Consider for instance this gem of wisdom from Article 15 (4) of the Nepal Human Body Transplant Act 2055 (1998 C.E). It asks doctors to certify that the donor of any organ will not immediately die or become disabled due to the donation. In other words, not only did it assume doctors to have the impossible powers of prescience – prophesizing the future of patients to a certainty, it also lucidly showed that these laws weren’t written by or consulted with medical professionals. It shows a complete disregard and ignorance for the possibility of complications which are further multiplied by the lack of resources that hospital and health services are dealing with. But the Transplant Act of 2016 brings good tidings in the form of organ availability from brain dead people, provided that the person hadn’t specifically declined consent while being alive. The law also provides for a novel way of organ donation where two compatible donors from different families can exchange their organs.
We still have a long way to go. Amending the law to the best practices that can save the most amount of lives should a major priority. Allowing transplants from non-related people will ensure that the majority of people will not be denied organ transplantation due to the motivations of a few bad apples. This also involves technical details that need to be detailed out such as the issue on brain death. Another priority will be step up efforts to curb the trafficking of organs by increasing awareness and education in the most prone villages on this topic. This should be aided by the renewed ability of concerned villagers and social service workers to directly contact their ward council members and mayors after this local election.
The government, through the Ministry of Health, needs to step up in its efforts to assist, primarily by covering the expenses for the extraction process. Hospitals must ensure the availability doctors, nurses, surgeons and other required personnel at the time of extraction. Using available budget for implementing the latest technology in medical innovation will increase the number of lives that can and will be saved. The question still remains on whether the increased proximity of power implementation through the local elections will actually make a difference in the lives of kidney-trafficking victims in Hokse and other villages, At its core, progress will come from reinforcing the social, economical and educational fabric of these communities. But, like the local elections, it will take social participation on a large scale to effect big changes.