26 Dec 2014 -1 Jan 2015 #738

A kidney has no gender

But transplants are heavily skewed in favour of men
Binita Dahal

Lack of awareness about fluid intake and overwork has exposed many Nepalis to the risk of kidney failure, but a breakdown of kidney transplants reflects a deep gender disparity.

After transplants were first performed in Nepal six years ago, nearly 400 patients have received kidneys from donors. But 90 percent of them are men, and 80 per cent of the donors are women.

The Human Organ Transplant Centre (HOTC) in Bhaktapur (pic, right) has performed 56 kidney transplants in the past year of which only eight are women.

One of them is Zarina Shrestha, 33, whose story is emblematic of the problems faced by female kidney patients needing transplants.

When her body started swelling a year ago, Zarina became a double victim: of the disease and her husband’s unkindness. When both her kidneys failed, she needed a transplant. On the way back from hospital, she remembers hoping that her husband could donate her one of his kidneys.

Zarina Shrestha
Instead, he got angry in the car and shouted at her for having contracted such an expensive disease. “I never thought my husband could say such harsh words when I needed his support the most, he screamed at me saying how unlucky he was to marry me and said he would marry another woman to help him with household work.”

Zarina sobbed as she related this from her hospital bed last week after finally receiving a kidney from her brother. She needs a dialysis twice a week and the procedures cost her Rs 35,000 each time besides the Rs 500,000 for the transplant operation itself. 

“My father passed away when I was a toddler, so my brother took his place for me, he has been taking care of me since and came to my rescue,” she says, adding that her brother is also paying for all her expenses.

Zarina has a 12-year-old son who came forward to offer one of his kidneys when he found out his father refused. Zarina’s brother immediately said he would donate his kidney to his sister when he heard of her need. 

The HOTC’s Pukar Chandra Shrestha says Zarina is the first woman who was offered kidney by her brother. He said it was rare for a male donor to come forward to help a female relative. There are only a few cases where a husband donates a kidney to the wife.

“I am ashamed to say that Nepali men are very selfish and don’t offer to save the lives of female family members, even when they know that the donor can live with one kidney,” Shrestha told us. “Mothers, sisters, wives come forward readily to donate their kidneys to ailing relatives, but not the husbands and brothers, that is the bitter truth.”

To address this gender disparity in kidney donation, HOTC and Aarogya Foundation have started giving Rs 50,000 to male donors. Zarina’s brother was the first donor to receive the incentive.

Every year, 3,000 Nepalis need kidney transplants and this number is growing with urbanisation and lack of awareness about precursor factors like dehydration, chronic infections and untreated hypertension. Only 10 per cent of kidney patients get proper treatment, and most patients can’t afford transplants.

"Dialysis is not a long-term solution, kidney patient must transplant to have a longer life," Shrestha said, "but it is expensive, even I can’t afford the expenses if I got a transplant.”  

Nepali law forbids kidney transplant outside immediate family members to control the illegal kidney trade, but experts say an amendment is needed to prevent people from going to India for transplant if a family member doesn’t agree to donate.

Zarina is grateful to her brother for saving her life, but many other female kidney patients in Nepal are not so lucky. For doctors like Shrestha this is a manifestation of patriarchy that they see every day in their kidney ward. He says: “I have seen parents pressuring their sons not to donate kidneys to their daughters-in-law, in most cases the feeling is if she dies he can always marry a healthy woman.” 

Read also:

Staying alive, Naresh Newar

The worst disease for a Nepali, Alok Tumbahangphey

Keep your kidneys running, Dhanvantari

Life transfusion, Jemima Sherpa

Misdiagnosed and ill-treated, Sophia Tamot

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