Only 2% undergo kidney transplants in Bangladesh. Inadequate facilities, legal bar blamed

On average, 30,000 to 40,000 patients suffer permanent kidney damage in the country every year, and only 10% of those who have no choice but to undergo dialysis or transplant receive this benefit.

Due to legal complications and inadequate facilities, only 2% of patients can undergo kidney transplants in the country. About 1,200 to 1,500 patients annually undergo kidney transplants abroad without recourse to close relatives as donors, spending almost ten times more money and presenting forged documents.

While money flows out of the country, the number of patients is increasing due to a lack of proper follow-ups by donors. Dialysis facilities outside Dhaka are also inadequate.

According to data from the Directorate General of Health Services (DGHS), 3.8 crore people in the country are currently suffering from some form of kidney disease. Among them, 30-40 lakh patients have permanent kidney damage.

About 60% of patients in the country are unaware that they are suffering from hypertension or diabetes. The silent killers, diabetes, and hypertension, are driving up the number of kidney patients.

In such a situation, World Kidney Day is being observed today in the country with the theme "Kidney Health for All – Advancing Equitable Access to Care and Optimal Medication Practice".

While 250 kidney transplants are conducted annually in the country, kidney experts believe that approximately 10,000 transplants are needed each year.

Professor Dr Habibur Rahman Dulal, head of the renal transplant department at Bangabandhu Sheikh Mujib Medical University (BSMMU), told The Business Standard, "The number of transplants is far less than what we need. There are two reasons behind this. One is that the law lacks a provision to allow kidney donation without a relative, resulting in those without relatives being unable to receive a kidney. Additionally, the centres we have lack the capacity to perform so many transplants."

He mentioned that the majority of patients are opting to go abroad for transplants. Those without relatives are resorting to forging documents and traveling abroad for a kidney transplant at a cost of around Tk50 lakh.

"In addition to the high cost, there is no follow-up from the donors. Due to the lack of donor follow-up, the one kidney they have is often compromised, leading to increased pressure on the patient," he added.

According to Bangladesh's law, kidneys can be obtained from 22 types of relatives. Under the Transplantation of Human Organs (Amendment) Act 2018, the kidney of a close relative can be taken to save a life. Next of kin includes mother, father, son, daughter, brother, sister, husband, wife, uncle, aunt, grandparents from both maternal and paternal sides, grandchild, and cousin. No other relatives are permitted to donate a kidney.

Professor Dr Habibur Rahman emphasised that, besides relatives, close friends and emotionally connected individuals express interest in donating kidneys altruistically, without any financial transaction involved.

He said, "However, the current complexity of the law prohibits this practice, leading people to seek transplantation services abroad. This results in a significant outflow of the country's financial resources. Moreover, the persistence of kidney brokers exacerbates the situation."

Therefore, it is imperative to incorporate provisions for "emotional donors" into the law. Additionally, stringent monitoring mechanisms should be established to prevent illegal kidney trading, he added.

Kidney transplant facilities inadequate

At the government level, only the National Institute of Kidney Diseases and Urology (NIKDU) and Bangabandhu Sheikh Mujib Medical University (BSMMU) perform kidney transplants.

In the private sector, kidney transplants are carried out at the Kidney Foundation, Center for Kidney Diseases and Urology Hospital (CKD), BIRDEM, and Evercare Hospital.

At NIKDU, patients only need to pay for the cost of medicines, making kidney transplants effectively free. A two-week package at BSMMU costs Tk1.7 lakh, while it rises to Tk3 lakh in super-specialised hospitals.

In private hospitals, the cost varies, typically ranging from Tk3 lakh to Tk5 lakh. For patients seeking transplants abroad, the cost is approximately Tk50 lakh.

Although there are some kidney dialysis centres outside Dhaka, they are often limited in scale and fail to meet demand. However, according to the DGHS, there are sufficient dialysis facilities in Noakhali.

Increasing cadaveric kidney transplants to reduce the crisis

On 18 January 2023, the country witnessed its first cadaveric kidney transplant. The kidneys of Sara Islam, a brain-dead patient undergoing treatment in the ICU of BSMMU, were successfully transplanted into two patients.

Subsequently, in January of this year, the kidneys of brain-dead patient Md Masum Alam, aged 38, were transplanted into two kidney patients. Despite the introduction of cadaveric transplants in the country, there has been limited public response.

Professor Habibur Rahman Dulal emphasised the challenges of garnering public interest in kidney transplants from brain-dead patients.

He noted that significant efforts are required to persuade individuals about the viability of this option. Full-scale implementation of cadaveric transplants could provide many kidney patients with much-needed relief, ultimately alleviating the kidney crisis in the country.

Professor Dr Harun Ur Rashid, president of the Kidney Foundation and Research Institute, highlighted the fact that in various countries around the world, the kidney transplant rate comprises 30% from living relatives and 70% from cadaveric transplants.

"Cadaveric transplants are successfully performed in Islamic countries, particularly in Saudi Arabia, Iran, and Kuwait. It is crucial for people in our country to comprehend the potential of this procedure. Given the complexity of this disease and the exorbitant costs associated with treatment, prevention should be considered the primary strategy," he asserted.

Professor Dr Robed Amin, director of non-communicable diseases at the DGHS, said diabetes and hypertension medications are now provided free of charge at the NCD corners of upazila health complexes.

"Starting next year, we will introduce Multistix at these corners. Health workers will be able to use this stick to test protein and sugar levels, enabling early identification of kidney patients," he elaborated.

Furthermore, Dr Amin revealed that the government has initiated the establishment of kidney units in conjunction with cancer hospitals in eight divisional towns where the number of kidney patients is on the rise. This measure aims to enhance access to kidney-related benefits and services.