The Ministry of Health (MoH) is working on a revised draft referral guideline to facilitate and ease the procedures for kidney transplantation. While ABO- incompatible kidney transplantation has been successfully performed in India, Bhutan’s referral policy does not permit such procedures, prolonging the suffering of patients and their families and also placing a burden on the government’s resources.
Records with the Bhutan Kidney Foundation (BKF) reveal that over 411 Bhutanese are undergoing dialysis for not getting potential kidney donors.
During the 11th meet-the-press on Friday, Health Minister Tandin Wangchuk said that currently incompatible transplanting is done in India (Kolkata or Vellore), but as per Bhutan’s existing guideline, incompatible transplantation is not allowed. “The draft revised referral guideline includes provisions for ABO-incompatible kidney transplants. This revision was made to address the challenges faced by patients who are unable to find compatible donors,” the Minister said, adding that once the guideline is finalized, it will be presented to the High-Level Committee of the Health Sector (HLC) for recommendation and then submitted to the government for approval.
ABO-incompatible kidney transplant is a kidney transplant performed even when the blood types of the donor and the recipient do not match. The procedure is that the antibodies in the patient’s blood react to the donor’s blood type. This reaction would result in an unsuccessful transplant. This is why, in the past, the only option was to identify the type of blood group of the donor and patient and see if it matched. Otherwise, surgery was not possible.
Nevertheless, advancement in medicine and technology has made it possible for transplants to happen between some recipients and donors, even if the blood type does not match, which was not possible earlier, increasing the availability of kidney transplants and reducing the number of patients on waiting list. However, medical treatment is required to be given to the patient before and after the ABO transplant to lower the antibody level in the blood and hence reducing the chances that the antibodies reject the donor’s kidney.
While the implementation of ABO-incompatible transfer is estimated to incur an additional cost of approximately Nu 200,000-250,000 per patient compared to compatible transplants, the Minister said, “The provision aims to alleviate the suffering of patients and their families while reducing the long-term financial and emotional burdens they currently face. Ensuring accessibility to this advanced medical procedure aligns with the government’s commitment to providing equitable healthcare services.”
In addition to the transplant guideline revision, the draft also includes an update to the Daily Subsistence Allowance (DSA) for patients and their escorts. The proposed DSA rate will be Nu 400 per person per day, which is aligned with the minimum national wage rate and accounts for inflation and the recommendations from the BKF’s case studies.
According to the Minister, this increase is a necessary adjustment, as the current DSA rates of Nu 150 for the first month and Nu 125 from the second month were established over two decades ago and no longer reflect the current cost of living.
The Minister said that although this adjustment will increase DSA expenses by approximately threefold, “It is expected to provide patients and their escorts with sufficient financial support to meet their daily expenses during treatment, alleviating the struggles many currently face,” said Lyonpo Tandin, adding that this revision demonstrates the government’s commitment to enhancing the welfare of referred patients and their families, ensuring they can focus on recovery by reducing undue financial burden.
By Nidup Lhamo from Thimphu
