KATHMANDU, NEPAL — When Sushrita Thapa’s kidneys failed at 19, she expected that one operation would fix everything. Instead, her world narrowed to beeping machines and thrice-weekly dialysis sessions, replacing textbooks and career ambitions.
Finding a donor proved brutal. Her mother’s blood type didn’t match, and her father refused. When Sushila Thapa, her mother, discovered organ transplants from brain-dead patients as an option, relatives balked: “How could you accept organs from someone who’s dead?” “That’s against our religion!”
Undeterred, Sushila Thapa added her daughter to a 500-person waiting list. For months, they dutifully updated medical reports every quarter. Then one June evening in 2022, the phone rang: “Come immediately. We might have a kidney.”
If you need a kidney transplant in Nepal, your odds vary dramatically based on donor type. Between 2017 and 2024, over 1,000 people awaited kidneys from brain-dead patients, contingent on approval from next of kin, while more than 7,600 were listed for living donors, according to information provided by the Ministry of Health and Population.
Each year, 3,000 more Nepalis endure kidney failure, but only 10% find living donors amid a critical organ shortage in the country. Though demand far outstrips supply, deep-seated cultural resistance remains to donations from brain-dead patients.
Since Nepal legalized organ donations from brain-dead patients in 2016 and the first transplant took place in 2017, just 13 people have received organs this way, compared to nearly 1,900 from living donors, according to data provided by Mrinal Chaudhary, the information technology officer at the health ministry.
Behind these numbers lies a struggle where tradition clashes with medicine.
“People fear being reborn incomplete,” says Dr. Kalpana Kumari Shrestha, nephrologist at the Shahid Dharmabhakta National Transplant Center in Kathmandu. “Some even accuse me of organ trafficking when I explain the process.”
More than 80% of Nepal’s population is Hindu, a religion that includes a belief in reincarnation. In Hindu communities here, immediate cremation is sacred. This practice, where the soul begins its journey after death, conflicts with organ donation.
“This contradicts Hindu Vedic teachings. Death occurs only when all organs cease functioning — only then can the soul depart,” says Ram Chandra Gautam, Sanskrit professor at Nepal Sanskrit University, Valmeeki Campus (Viddyapeeth).
In a culture centered on reincarnation and moksha, belief holds that life continues while the heart beats.
“We’re watching savable lives slip away,” says Dr. Pawan Raj Chalise, associate professor and head of the Department of Urology and Kidney Transplant Surgery at Tribhuvan University Teaching Hospital in Kathmandu.
Nepal’s transplant landscape transformed in 2016. While the Human Body Organ Transplantation (Regulation and Prohibition) Act of 1999 limited donor options, the 2016 amendment expanded “close relatives” to include 51 relationships and also recognized brain-dead patients as legitimate organ sources.
The Shahid Dharmabhakta National Transplant Center successfully performed Nepal’s first kidney transplant from a brain-dead donor in 2017 and remains the only hospital in the country with this capability.
Dr. Pukar Chandra Shrestha, director of the transplant center, advocated for eight years for the legal change, but says a lot still needs to be done.
The government is changing cultural attitudes through outreach to officials, community leaders and religious figures, while incorporating the topic into school curricula. It has increased financial support for donor families and participating hospitals.
Since the 2016 law passed, 2,627 people have registered to donate their organs after death, according to figures confirmed by Shrestha.
When Kopila Bhujel lost her 24-year-old husband in an accident, she was pregnant with their third child. Initially horrified by the doctors’ request for organ donation, she believed only cremation of the entire body as-is would bring peace to his soul. “I thought they were trying to sell his body,” she recalls.
After 12 hours of inner struggle and a lot of convincing by doctors and social workers at the hospital, Bhujel chose differently. Her husband’s kidneys saved two lives, and his liver, another.
“There is no greater religion than donation,” she says now, at age 30, working as a laborer to educate the children they’d dreamed about together. “He may be gone, but I feel his presence when I dream of him smiling, finally at peace.”
