When police and passers-by pulled Nisha out, she had sustained serious injures below her waist. She was rushed to Civil Hospital not far away from the scene of the accident. She was later transferred to Tribhuvan University Teaching Hospital where she breathed her last the next day.

Before Nisha was cremated at Pashupati Aryaghat, her family donated her eyes to Tilganga Institute of Ophthalmology. Her family members wanted Nisha’s eyes to provide vision to someone who is in need. It was a very thoughtful gesture with an equal measure of poignancy.

Like Nisha, many people have donated—or pledged to donate—their eyes upon their death and given the wonderful gift of vision to blind persons.

In Nepal, organ donation is limited to kidneys and eyes. Though bone marrow transplantation, too, has begun, it has  yet to catch on.

Dr Divya Singh, a senior nephrologist at the Tribhuvan University Teaching Hospital, said the government should also legalise the criteria in which brain-dead persons could donate their organs.

“It could save and prolong the life of many people,” Dr Singh said.

Organ transplantation in the country is regulated by the Human Body Organ Transplantation (Regulation and Prohibition) Act 1998 and the Kidney Transplantation (Regulation and Prohibition) Rules 2002. People with chronic kidney ailments either need dialysis for the rest of their lives or a kidney transplant. However, the 1998 Act only allows for “close relatives” to donate kidneys to patients, provided they are medically fit. A close relative is defined as son, daughter, mother, father, brother, sister, uncle, nephew, niece, grandfather, grandmother or legally adopted family members.

Doctors estimate that there are 3,000 cases of renal failure annually in the country as 1,000 cases of liver failure follows along with 3 million diabetics in Nepal.

The country is yet to brace itself for complex organ transplantation, but Dr Singh believes that the issue of kidney can be resolved through brain-dead donation.  

Brain death is a situation in which a person’s brain functions have completely and irreversibly ceased but the heartbeats and blood flow are maintained through mechanical ventilation and medications.

A brain-dead person could donate eight organs—eyes, kidneys, lungs, heart and a pancreas—if a mechanism for such organ donation is developed.

Dr Guna Raj Lohani, chief of Curative Division at MoHP said there are two school of thoughts while defining brain death. He said some say that brain death declaration should be defined by a separate Act, while others say that it can be included under the existing human organ transplantation Act. “We are discussing on this issue and will soon finalise it,” said Dr Lohani. “Apart from organ harvesting, it will also help health professionals to declare the demise of brain-dead patients.”

Dr Singh said since brain-dead persons have to be kept in ventilator before extracting the organs, there arises confusion regarding who is supposed to bear the cost of the extraction process. “Is it the deceased, the recipients or the government?” said Dr Singh. “In the developed world the government bears the cost.”

She also said that all health professionals, including surgeons, anaesthetists and other staff, must be ready for extraction and transplantation processes around the clock.

“This follows another process of selecting eligible recipients,” said Dr Singh. “Tracking down the recipients as registered in the central computer, which keeps the updated details, and making him or her available for transplantation within 48 hours of the organ extraction.”

Dr Singh said in 2015, the brain-dead criteria should be legalised and its implementation should begin from hospitals, including trauma centres and neuro-centres and big hospital such as Bir hospital and TUTH.

At present, those eligible for donations can undergo transplantation at TUTH and Bir Hospital at the cost of around Rs 500,000. Simlarly, the Bhaktapur-based Human Organ Transplant Centre has been conducting four transplants for Rs 350,000. An estimated 2.8 million people in Nepal have some sort of kidney ailments.