ObjectivesObjectives Discuss health system of NepalDiscuss health system of Nepal Describe the shifting trend in disease...
Nepal is known asNepal is known asLand of braveLand of brave “Gurkha warrier”“Gurkha warrier”Land of Himalayas,Land of H...
Mount EverestMount Everest& Buddha& Buddha
BakhtapurKathmandu Valley:Kathmandu Valley: World Heritage SitesWorld Heritage Sites ( Contd..)( Contd..)ChangunarayanBasa...
Kathmandu Valley -Kathmandu Valley - World Heritage SitesWorld Heritage SitesSwayambhunath Patan Durbar Squre
Basic CharacteristicsBasic CharacteristicsNepalNepal Area of 147,181 sq. kmArea of 147,181 sq. km Population:Population:...
Ministry of HealthDepartment of Health ServicesNHTCNHEICCNTCNCASCNPHLRegional Health Directorate - 5Central Hospitals - 5C...
Nepal Total Death by CauseNepal Total Death by CauseS.No. Particulars Deaths %1 Coronary Heart Disease 21,152 14.22 Influe...
Patients Increased in HemodialysisPatients Increased in Hemodialysis
 Kidney transplantationKidney transplantation Treatment ofTreatment ofchoice and preferredchoice and preferred Dialysi...
Treatment for Kidney Disease Remains ElusiveTreatment for Kidney Disease Remains Elusiveand Unaffordableand UnaffordableDr...
History on Kidney TransplantationHistory on Kidney Transplantationin Nepalin Nepal Three cases – nursing home (private ho...
HECAF-Nepal / National Kidney CentreHECAF-Nepal / National Kidney Centre
Study on Kidney Transplant RecipientStudy on Kidney Transplant Recipient A cohort retrospectiveA cohort retrospective Fo...
Lawful DonorsLawful DonorsLaw of the land defined: the potential kidneyLaw of the land defined: the potential kidneydonord...
Type of Hospital and CountryType of Hospital and Country93.75% - 45 different hospitals in India, 71.7% - private hospital...
Source of KidneysSource of KidneysUnrelated 315 (69.69%), related 134 (29.43%) and undisclosed 4 (0.88%)
EthnicityEthnicity
Age Group of RecipientsAge Group of RecipientsAgeAge NumberNumber ≤≤15 years15 years 4 (0.9%)4 (0.9%) 16-3016-30 113 (25...
Benefit of Kidney Transplantation…..…Back to Work (contd…..)
Croatian vs PolandCroatian vs PolandFinal Euro Cup 2008Final Euro Cup 2008played and won by 28 Yrs old Strikerplayed and w...
Donor Lisa George Danhw Recipient: Dan GeorgesDonor Lisa George Danhw Recipient: Dan GeorgesRelationship to donor: Spouse ...
Who Got His Kidney?Who Got His Kidney?Sellingkidneysfor afewrupeesmore
Kidney Stealing From PoorKidney Stealing From Poorhttp://www.canada.com/story.html?id=7a0f0f8a-daac-45f2-91c6-c4a3090d1e0d
 http://www.asianewsnet.net/Nepal-police-arrest-kidney-dealers-46735.htmlhttp://www.asianewsnet.net/Nepal-police-arrest-k...
Ex-student Leader Among 8 HeldEx-student Leader Among 8 Heldfor Kidney Tradefor Kidney TradeBANEPA, May 14: Police have ar...
ConcernConcern In some families there are four to five membersIn some families there are four to five memberswho have sol...
MessageMessage Tribhuvan University Teaching Hospital and BirTribhuvan University Teaching Hospital and BirHospital provi...
Where Are We?Where Are We? What is individuals professionalWhat is individuals professional’s role?’s role? Whether live...
Disrupting Ethical IssuesDisrupting Ethical Issues Renal care team members (Nurse, Nephrologist,Renal care team members (...
ConclusionConclusion Entire enterprise of transplantation is vulnerableEntire enterprise of transplantation is vulnerable...
Dr. Ram Dulal ‘Back-door’ Realities of Renal Transplantation global health rounds
Dr. Ram Dulal ‘Back-door’ Realities of Renal Transplantation global health rounds
Upcoming SlideShare
Loading in …5
×

Dr. Ram Dulal ‘Back-door’ Realities of Renal Transplantation global health rounds

1,148 views
1,022 views

Published on

" ‘Back-door’ Realities of Renal Transplant Donor-Recipient Relationships Disrupting the Ethics of Public Health " global health rounds presentation by Dr. Ram Dulal June 24, 2013 at the University of Alberta.

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,148
On SlideShare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
24
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Dr. Ram Dulal ‘Back-door’ Realities of Renal Transplantation global health rounds

  1. 1. ObjectivesObjectives Discuss health system of NepalDiscuss health system of Nepal Describe the shifting trend in disease patternsDescribe the shifting trend in disease patterns Discuss renal transplantation and issues ofDiscuss renal transplantation and issues ofpublic health ethics andpublic health ethics and ‘back-door’ reality‘back-door’ reality
  2. 2. Nepal is known asNepal is known asLand of braveLand of brave “Gurkha warrier”“Gurkha warrier”Land of Himalayas,Land of Himalayas,8 out of 10 world highest peaks8 out of 10 world highest peaksBirth Place of Lord Buddha,Birth Place of Lord Buddha,World Heritage sitesWorld Heritage sitesNepal At A GlanceNepal At A Glance
  3. 3. Mount EverestMount Everest& Buddha& Buddha
  4. 4. BakhtapurKathmandu Valley:Kathmandu Valley: World Heritage SitesWorld Heritage Sites ( Contd..)( Contd..)ChangunarayanBasantapur Durbar Square
  5. 5. Kathmandu Valley -Kathmandu Valley - World Heritage SitesWorld Heritage SitesSwayambhunath Patan Durbar Squre
  6. 6. Basic CharacteristicsBasic CharacteristicsNepalNepal Area of 147,181 sq. kmArea of 147,181 sq. km Population:Population: 26.5 million (2011)26.5 million (2011) Total fertility rate: 2.6 (2010)Total fertility rate: 2.6 (2010) Infant mortality: 65.3 per 1,000Infant mortality: 65.3 per 1,000 Life expectancy: 64.6 male/Life expectancy: 64.6 male/67.1 female (2010)67.1 female (2010) Per Capita health expenditures: US-$64 (Int.)Per Capita health expenditures: US-$64 (Int.) GDP per Capita US$ 500GDP per Capita US$ 500
  7. 7. Ministry of HealthDepartment of Health ServicesNHTCNHEICCNTCNCASCNPHLRegional Health Directorate - 5Central Hospitals - 5CENTRALLEVELRegionalLaboratory(1)RegionalTrainingCentre(5)RegionalMedicalStore(5)RegionalTBCentre(1)REGIONALLEVEL (5)ZONALLEVEL (14)Zonal Hospital - 11District PublicHealth Office - 14District Health Office61DISTRICTLEVEL (75)Primary Health Care Centre/Health Centre - 188ELECTORALCONSTITUENCY(205)Health Post - 698Sub Health Post - 3,129FCHV48,307TBA15,553PHC ORC Clinic14,769EPI Outreach Clinic15,833COMMUNITYLEVELVDC LEVEL (3,995)FHDCHDEDCDMDLMDD I V I S I O N S C E N T R E SRegionalHospital(1)LCDDistrict Hospital62District health system is integrated – preventive and curative servicesDistrict health system is integrated – preventive and curative services
  8. 8. Nepal Total Death by CauseNepal Total Death by CauseS.No. Particulars Deaths %1 Coronary Heart Disease 21,152 14.22 Influenza & Pneumonia 18,406 12.43 Stroke 11,119 7.54 Diarrhoeal diseases 7,787 5.25 Tuberculosis 6,330 4.36 Lung Disease 5,973 4.07 Birth Trauma 5,967 4.08 Low Birth Weight 5,584 3.89 Hypertension 5,570 3.810 HIV/AIDS 4,796 3.211 Diabetes Mellitus 3,224 2.212 Lung Cancers 3,100 2.113 Maternal Conditions 2,791 1.914 Road Traffic Accidents 2,527 1.715 Violence 2,455 1.716 Othe Injuries 2,358 1.5917 Kidney Disease 2,212 1.49http://www.worldlifeexpectancy.com/country-health-profile/nepal
  9. 9. Patients Increased in HemodialysisPatients Increased in Hemodialysis
  10. 10.  Kidney transplantationKidney transplantation Treatment ofTreatment ofchoice and preferredchoice and preferred DialysisDialysis Temporary inTemporary in EndEndStage Renal DiseasesStage Renal DiseasesKidney TransplantKidney Transplant
  11. 11. Treatment for Kidney Disease Remains ElusiveTreatment for Kidney Disease Remains Elusiveand Unaffordableand UnaffordableDr. Sudha Khakurel, Chief of Nephrology Unit at BirDr. Sudha Khakurel, Chief of Nephrology Unit at BirHospitalHospital
  12. 12. History on Kidney TransplantationHistory on Kidney Transplantationin Nepalin Nepal Three cases – nursing home (private hospital) inThree cases – nursing home (private hospital) in19961996 One case – central govt hospital (Bir Hospital)One case – central govt hospital (Bir Hospital)in November 2004in November 2004Prior to August 2008, abroad for transplantation mostly to Indiauntil TUTH, Nepal started..Bir Hospital & TUTH
  13. 13. HECAF-Nepal / National Kidney CentreHECAF-Nepal / National Kidney Centre
  14. 14. Study on Kidney Transplant RecipientStudy on Kidney Transplant Recipient A cohort retrospectiveA cohort retrospective Follow up registryFollow up registry June 16, 2003 to July 15, 2008.June 16, 2003 to July 15, 2008. Population 452 transplantPopulation 452 transplantrecipientsrecipients
  15. 15. Lawful DonorsLawful DonorsLaw of the land defined: the potential kidneyLaw of the land defined: the potential kidneydonordonor’s can be:’s can be: father, mother, sister, brother, husband, wife, son,father, mother, sister, brother, husband, wife, son,daughter, uncle, aunt, sworn friend (Mitajyu),daughter, uncle, aunt, sworn friend (Mitajyu),mother-in-law and father-in-lawmother-in-law and father-in-law
  16. 16. Type of Hospital and CountryType of Hospital and Country93.75% - 45 different hospitals in India, 71.7% - private hospitals – IndiaOut of 45 - No. of cases 190, 58 and 25
  17. 17. Source of KidneysSource of KidneysUnrelated 315 (69.69%), related 134 (29.43%) and undisclosed 4 (0.88%)
  18. 18. EthnicityEthnicity
  19. 19. Age Group of RecipientsAge Group of RecipientsAgeAge NumberNumber ≤≤15 years15 years 4 (0.9%)4 (0.9%) 16-3016-30 113 (25.0%)113 (25.0%) >> 90%90% 31-4531-45 156 (34.5%)156 (34.5%) 46-6046-60 144 (31.9%)144 (31.9%) 61-7561-75 35 (7.7%)35 (7.7%)Male to female ratio of 3:1.
  20. 20. Benefit of Kidney Transplantation…..…Back to Work (contd…..)
  21. 21. Croatian vs PolandCroatian vs PolandFinal Euro Cup 2008Final Euro Cup 2008played and won by 28 Yrs old Strikerplayed and won by 28 Yrs old StrikerIvan Klasnic after 2Ivan Klasnic after 2ndndRenal TxRenal TxBenefit of Kidney Transplantation…..…Back to Work
  22. 22. Donor Lisa George Danhw Recipient: Dan GeorgesDonor Lisa George Danhw Recipient: Dan GeorgesRelationship to donor: Spouse Date of donation: May 24, 2002Relationship to donor: Spouse Date of donation: May 24, 2002Your gift has given me anew outlook on life, ourfamily, and our marriage.I thank God every day foryou and our children,David and Alexandra. Mylife is not completewithout you. And nowthat youre truly a part ofme, physically, I know Icannot be completewithout you. I love you,>Danhttp://www.livingdonorsonline.org/halloffame.htm
  23. 23. Who Got His Kidney?Who Got His Kidney?Sellingkidneysfor afewrupeesmore
  24. 24. Kidney Stealing From PoorKidney Stealing From Poorhttp://www.canada.com/story.html?id=7a0f0f8a-daac-45f2-91c6-c4a3090d1e0d
  25. 25.  http://www.asianewsnet.net/Nepal-police-arrest-kidney-dealers-46735.htmlhttp://www.asianewsnet.net/Nepal-police-arrest-kidney-dealers-46735.html
  26. 26. Ex-student Leader Among 8 HeldEx-student Leader Among 8 Heldfor Kidney Tradefor Kidney TradeBANEPA, May 14: Police have arrested eight persons including a former vice-presidentof Free Student Union of Patan Campus on the charge of their involvement in kidneytrade.A special team of police dispatched from Kathmandu arrested the eight individuals fromdifferent parts of the country within a period of one month and paraded them before themedia at Dhulikhel on Tuesday.The arrested have been identified as Puja Dahal aka Puna Thakuri and…………………….Among the arrested, Sachin Maharjan was reportedly a former vice-president of the FreeStudents Union at Patan Campus.Published on 2013-05-14http://myrepublica.com/portal/index.php/twb/?action=news_details&news_id=54697
  27. 27. ConcernConcern In some families there are four to five membersIn some families there are four to five memberswho have sold their kidneys.who have sold their kidneys. Kidney seller do not know who got his/herKidney seller do not know who got his/herkidney?kidney?The Nepali Kidney BankThe Nepali Kidney Bank byby Sunil NeupaneSunil Neupane          http://www.asiacalling.org/en/news/nepal/2010-the-nepali-kidney-bankhttp://www.asiacalling.org/en/news/nepal/2010-the-nepali-kidney-bankSaturday, 14 May 2011 18:16Saturday, 14 May 2011 18:16 The Village of Stolen KidneysThe Village of Stolen Kidneyshttp://www.youtube.com/watch?v=EE6cdPTkD5khttp://www.youtube.com/watch?v=EE6cdPTkD5k
  28. 28. MessageMessage Tribhuvan University Teaching Hospital and BirTribhuvan University Teaching Hospital and BirHospital provide kidney transplantationHospital provide kidney transplantation Rigorously selected lawful cases onlyRigorously selected lawful cases only Results presented are based on the data on kidneyResults presented are based on the data on kidneytransplantation done abroad, mostly in Indiatransplantation done abroad, mostly in India
  29. 29. Where Are We?Where Are We? What is individuals professionalWhat is individuals professional’s role?’s role? Whether live donor is lawful volunteerWhether live donor is lawful volunteeroror poverty driven, misinformed, forcefully mediatedpoverty driven, misinformed, forcefully mediated
  30. 30. Disrupting Ethical IssuesDisrupting Ethical Issues Renal care team members (Nurse, Nephrologist,Renal care team members (Nurse, Nephrologist,Radiologist/Sonologists, Pathologists etc.)Radiologist/Sonologists, Pathologists etc.)participation in the process of living donorparticipation in the process of living donorscreening and approvalscreening and approval Policy of homelandPolicy of homeland Initial Screening Process: Donor health and psychosocialInitial Screening Process: Donor health and psychosocialhistoryhistory Indication / contra-indicationIndication / contra-indication
  31. 31. ConclusionConclusion Entire enterprise of transplantation is vulnerableEntire enterprise of transplantation is vulnerable Protect ignorant and poor kidney sellerProtect ignorant and poor kidney seller Protect health care workers (renal) byProtect health care workers (renal) byimplementing an appropriate / robust guidelinesimplementing an appropriate / robust guidelines

×