Prof.Dr.Shyam P Lohani

Organ transplantation is the process of surgically removing healthy organs or tissues from one person and transplanting them into another person. Transplantation is taken as one of the greatest advances in modern medical science. Transplanting an organ is necessary for a person when his/her organ has failed or damaged due to a disease or injury. Moreover, people requiring organs greatly outnumber the actual donors and many of them die while waiting for organs. Organ transplantation gives a new and wonderful lease of life to recipients. So, it is life-saving for the recipient and improves the patient’s quality of life. For example, it is not necessary for a patient of kidney problem after its transplantation. The person suffering from cornea problem also does not need to restore his/her sight following a cornea transplant. Sometimes a single recipient undergoes transplantations for several times. There has been a world record of the seventh kidney transplantation on a single patient in The Netherlands.

Status
Every year thousands of transplantations are carried out worldwide and as estimated around 139,024 transplants were done worldwide in 2017 (Statista, 2019). The kidney is the most commonly transplanted organ worldwide followed by the liver and the heart. However, many other organs are being transplanted. A total of 90,306 kidney transplants, 32348 liver transplants, and 7,881 heart transplants were performed worldwide in 2017. The first renal transplant from a living donor in Nepal was performed successfully at the Tribhuvan University Teaching Hospital (TUTH) in 2008. Since then, a few other government and private hospitals have been carrying out kidney transplantations regularly.
Prime Minister KP Sharma Oli underwent a second kidney transplant surgery at TUTH on March 4. The successful surgery shows that Nepali doctors are capable of performing renal transplantations.
However, the number of transplantations in the country is relatively small as compared to around 3,000 people in need of renal transplantation alone every year. The Human Organ Transplantation Centre in Bhaktapur performs about 150 kidney transplants per year. A first liver transplant was carried out successfully in Nepal at that health facility in 2016. The first brain death donor's kidney transplant was performed on May 11, 2017 at the same institute.
Transplantation is the best or only option in case of end-stage organ failure but at the same time, it is usually challenging and complex. The organ or tissue that can be transplanted includes the kidney, liver, heart, pancreas, lung, intestine, cornea, middle ear, skin, bone, bone marrow, heart valves, and connective tissue. Recently vascularised composite allografts (transplant of several structures that may include skin, bone, muscles, blood vessels, nerves, and connective tissue) are now possible which also include hand and face transplantation. Sometimes double transplants such as kidney/pancreas and heart/lung can also be performed.
Organ transplantation is major surgery and also has several drawbacks such as there is also a chance of organ rejection. People of all ages can donate their organs. The conditions such as polycystic kidney disease, genetic disease such as cystic fibrosis, or a heart defect cause people to seek for an organ transplant. A person requires a transplant in infections such as hepatitis, physical injuries to organs, and damage due to chronic conditions such as diabetes and high blood pressure. The transplant process varies depending on the organ. However, a common requirement is matching the donors. Both the donor and recipient should have compatible blood types. Other factors are also important in organ transplants such as compatible antibodies and similar body size in case of a kidney transplant.
The organ recipient needs to stay in hospital for a few days after the transplant. The duration of stay in the hospital depends on various factors such as how well the surgery went, and the recipient’s overall health. The recipients need to take anti-rejection medication (immunosuppressant) to counteract the rejection of the grafted organ by the body. These medications weaken the immune system which lowers the body’s capacity to fight infections; therefore, the organ recipients must avoid infections.
The organs from living donors are found functioning better as well as for longer periods than those from deceased donors. A kidney from a living donor works for an average of 12–20 years, whereas a kidney from a deceased donor lasts around 8–12 years. Organs can be donated by both living and deceased donors. Healthy living donors can donate a kidney, a lung, or a portion of the pancreas, liver, and intestines whereas a deceased donor can donate two kidneys, two lungs, the heart, corneas, pancreas, and intestines. A deceased donor may also donate body tissue, such as heart valves, tendons, or skin.
The organ transplant is also associated with risks ranges from complications related to the use of anesthesia, including death to bleeding or other complications during the surgical procedure to post-surgical complications, such as healthcare-associated infection, a higher risk of infections and other illnesses due to immunosuppressant or other transplant-related drugs, organ rejection and organ failure. Rejection happens when the immune system attacks the newly transplanted organ. The recipient must take drugs for the rest of their life to help keep the body from rejecting the new organ.

Organ donation
Nepal formulated the first Human Organ Transplantation Act in 1998 A.D. which was aimed at controlling the trade of kidneys and only the immediate relatives could donate their organs. The Act was amended and the Human Organ Donation Act 2072 B.S. and Regulations 2073 opened the doors for organ donation from clinically dead persons, donor exchange programmes and expansion of living donor pool. The amendment to the Act has allowed the removal of organs (kidneys, lungs, heart, liver pancreas and small intestine) from the clinically dead people and their transplant to the needy individuals. The amendments also expected to help expand living donors' eligibility for organ donation and at the same time protect the poor and marginalized from organ trafficking.
The rate of cadaveric organ donation is very low in Nepal owing to a low level of awareness, social, cultural and superstitious beliefs. There is a need for large scale awareness programmes throughout the country about organ donation after death. There are a limited number of transplantation facilities in the country. Therefore, it is also recommended that the government consider for expanding transplantation services to other parts of the country as well.

(Prof. Lohani is the Founder and Academic Director of Nobel College. He can be reached at lohanis@gmail.com.)