If you are poor and your close relatives refuse to donate you a kidney, your chances of surviving long with the damaged organ are really slim, thanks to the authorities' inaction over widening up donation options.
On the other hand, patients with deep pockets can fly abroad and undergo easy surgery at Tk20-40 lakh.
The two different types of medical care at home and abroad are starkly juxtaposed with a 2019-High Court order that instructed the authorities to amend the Human Organ Transplantation Act, allowing people who do not fall among 24 types of relatives of the patient to go for kidney donation.
The HC asked the government to carry out the changes to the law within six months. But the act was not amended even in the last one-and-a-half years, resulting in immense suffering for kidney patients.
As many as 10,000 patients require kidney transplants every year, while Bangladesh carries out only 250 of the surgeries owing to legal complexities of the transplant, said physicians.
They said the rest of the patients who cannot afford kidney transplants abroad face costlier dialysis and ultimately inch towards premature death.
Doctors said if there is an available donor, kidney transplant is an easy surgery compared to coronary artery bypass, and costs only Tk2-3 lakh in the country.
"The transplant in foreign countries costs at least Tk20 lakh, plus the follow-ups," Dr Mohib Ullah Khondoker, coordinator at the Gonoshasthaya Dialysis Centre, told The Business Standard.
"But if the court directives had been implemented, the patients could have had the transplants at home at a much lower rate. The HC directives widened up the donating options a lot," Dr Mohib Ullah noted.
According to the Human Organ Transplantation Act-1999, 24 types of relatives, such as parents, adult sons and daughters, adult brothers and sisters, uncles and aunts from both paternal and maternal sides, and spouses can donate kidneys.
On 5 December 2019, the High Court ruled that voluntary donors beyond the specified categories of certain relatives could also donate kidneys.
The court ordered the government to bring about an amendment to the Organ Transplantation Act-1999, incorporating the provision in six months so that emotional donors, including close relatives, could donate kidneys to patients in line with the conditions.
Wishing anonymity, an additional secretary at the health ministry said the ministry had asked the law ministry for its opinion following the court order, and the next step would be taken after the law ministry's action.
Dr Mohib Ullah said many patients continue dialysis at Gonoshasthaya hospital since they cannot have transplants owing to donor complexities.
"It is urgent to implement the court directives to reduce the sufferings of the patients," he noted.
1,500 transplants in 39 years
Physicians said only 1,500 kidney transplants have taken place in 39 years due to legal complications, though Bangladesh has all the kidney transplant facilities, including hospital arrangements and specialist doctors.
Of the transplants, about 800 took place in private hospitals.
Kidney transplants had been suspended at the National Institute of Kidney Diseases & Urology for seven years owing to legal issues, and were resumed in August this year.
After a one-and-a-half-year pause, Bangabandhu Sheikh Mujib Medical University Hospital (BSMMU) also resumed kidney transplants in October.
BSMMU urology Professor Dr Habibur Rahman Dulal said the hospital has a plan to conduct at least one transplant per week.
"But the problem is the donor crisis as some medical middlemen lure patients to foreign hospitals. The number of transplants at government hospitals will rise if the legal issues are disposed of," he commented.