Gender disparities in living and deceased organ donor pool continue

There are gender disparities in the living and deceased organ donor pool in Nepal, shows the data with the Shahid Dharmabhakta National Transplant Centre (SDNTC).

Out of the total donors so far, a whopping 78 percent are women, and only 22 men. Interestingly, the recipients of organs donated by women are all men, and the number of women recipients of organs donated by men is negligible. This has been influenced in part by the rate of donation refusal by men, it has been said.

"In view of organ donation among family members, a wife easily agrees to donate organs to her husband. But a husband does not. Daughters follow suit. But sons do not. There is a mindset that in most cases, men deem it unnecessary to donate organs to women, which should be eliminated," viewed the SDNTC executive director Dr Pukar Chandra Shrestha.

To encourage organ donation, there is a provision that men will be provided with Rs 50,000 for donating their organs to women. But this has not helped, it seems. Women have been prioritised three folds when it comes to receiving kidney transplant from those people whose brain dies, he said.

Women are still considered citizens of second rank in the society. The old perception that men are sole members to look after the family has contributed to their denial in donating their organs. This is a result of patriarchy, viewed rights activist Pratima Sharma. “Violence against women stems from households and at the hand of husbands. Women are ready to sacrifice everything they have to their husbands in need. But men only use women,” she said.

Utilitarianism has led to men not having compassion towards women, she said. “A big investment is needed to change the mindset of men and the society towards women. All including the government, and the private sector should work from their respective places, and the education curriculum should be created accordingly,” she said.

To end sex disparities, the patriarchal structure should be changed, and the governments at all the three levels should create awareness at people’s doorsteps, she suggested.

Organ donation after brain death commenced in Nepal from 2074 BS with the aim that no one should lose their life due to lack of organs. People above 18 years of age can voluntarily donate their organs to their relatives for the purpose of treating a disease as per the Human Body Organ Transplantation (Regulation and Prohibition) Act, 2055 BS. Similarly, one can donate their organs after brain death.

According to Dr Pukar, around 3,000 kidney patients required transplant on a yearly basis in the country. But kidney transplant took place on only around 300, and remaining 2,700 also required transplant. But lack of kidneys has hit the matter, he said.

Lack of substantial awareness about organ donation and transplant has led to people dying untimely for want of organ transplant, he said. “Healthy people are reluctant to donate their organs. Families and relatives do now allow the removal of organs from deceased people,” he said.

So far, around 1,100 people have got kidney transplant in Nepal. All the donors are healthy, and kidney donors have the same life expectancy, general health and kidney function as non-donors, he said. When the kidney is removed, the single normal kidney will increase in size to compensate for the loss of the donated kidney.

“We have the misconception that transplants are not required after dialysis. But dialysis can save people only temporarily. Transplant means for people to be free from diseases, and generally live a quality life,” he said. Around 30,000 dialysis sessions took place yearly in Nepal, he said.

People of any sex between 18 and 65 age group can donate living and deceased organs if they have not suffered from diabetes, blood pressure, cancer and other infectious diseases. People above 65 can also donate their organs if they are healthy, doctors say.

According to the Act, a person who commits an offence of extracting any organ of another person or transplanting the extracted organ to another person or using it in another work or directly involving in such act shall be punished with imprisonment of a term not exceeding five years, and a fine not exceeding Rs 500,000.

Although organ donation after brain death is much effective way when it comes to organ transplant, lack of awareness has made the matter worse, said Dr Kalpana Kumari Shrestha of the SDNTC. Eye donation is much easier, she said.

So far in Nepal, over 2,700 people donated their organs after brain death, and around 2,200 have announced organ donation after brain death, she said, adding that there is a need for making people aware about the importance and necessity of organ donation to end the situation wherein people have to lose their lives due to lack of organs.

According to her, organ extraction after brain death is possible with consent from the family members and relatives when the donor is declared dead after brain death in hospital. Only eyes can be extracted even when the donor dies at home.

A person is officially declared dead after a team of specialist doctors carries out two examinations in a gap of six hours to ensure their brain death, said Dr Pukar Chandra. "A donor dies. Their family and relatives are in mourn. In this situation, there is a struggle to convince the family and relatives to remove body organs from the deceased as per the deceased's agreement before death," he said.

According to the SDNTC, kidneys extracted from the donor after brain death can be transplanted within 24 hours. In case of heart, it can be transplanted within six hours, livers within 15 hours, lungs within eight hours, and small intestine within 10 hours. The whole body remains intact even when body organs are retrieved, he said.

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