The first liver transplant in Nepal was a groundbreaking medical achievement. It marked a significant milestone in the country’s healthcare history. Dr. Ramesh Singh Bhandari, a renowned Gastrointestinal, HPB (Hepatopancreatobiliary), and Liver Transplant Surgeon, played a pivotal role in introducing liver transplants in Nepal.12th Jan 2024 (2080 Poush 27 BS) A team of 50 people including Dr. Bhandari has successfully transplanted a liver from a 40-year-old wife to a 41-year-old husband.
His dedication to advancing medical science and improving patient outcomes has made a lasting impact on the healthcare landscape. The successful liver transplant surgeries performed by Dr. Bhandari have not only saved lives but also paved the way for further advancements in organ transplantation within Nepal
Dr. Ramesh Singh Bhandari is a distinguished Gastrointestinal, HPB (Hepatopancreatobiliary), and Liver Transplant Surgeon. His successful career is characterized by a commitment to medical excellence, all while striving to make life-saving liver transplants more accessible. Dr. Bhandari has played a pivotal role in introducing liver transplants in Nepal, contributing significantly to the field of healthcare in the country.
He is a professor specializing in Liver and Gastrointestinal Surgery. His expertise lies in liver, pancreas, and biliary surgeries, as well as liver transplantation. Dr. Bhandari’s dedication to advancing medical science and improving patient outcomes has made a lasting impact on the healthcare landscape.
The first liver transplant Doctor Biography
Dr. Ramesh Singh Bhandari, who was born in Baitadi district of Farwestern Province, left his native land to study at the age of 5 and went to Kathmandu with his uncle to get his education. Doctor Ramesh was born and brought up in a military family. Doctor who passed SLC from VS Niketan School. He passed Plus Two from Birendra Sainik School and passed MBBS from BPKIHS Dharan.
Those who knew him, seeing his diligence in his studies, said – ‘You will become a doctor’. His desire is the same. Pursuing a desire, did MBBS from BP Koirala Institute of Health Sciences, Dharan. Then he started working in the same pediatric department. After 10 months, Dharan returned.
He wanted to do MD in pediatrics. However, since there was no study of that course in Dharan at that time, his harmony did not match. In 2003, he returned to the teaching hospital Kathmandu to do the ‘MS General Surgery’ course. The work also started.
Bhandari has done MCH in General Surgery from Teaching Hospital Maharajganj. He also completed a fellowship in liver transplantation from the Royal Australasian College of Surgeons in Melbourne, Australia. And that ‘fellowship’ became an important turning point in his life.
‘Can a liver transplant be done in Nepal or not?’ He was in ‘confusion’ before going to Australia. Having done liver and pancreas surgery, ‘What next?’ He kept asking himself that question. Australia’s ‘Fellowship’ answered ‘What next’ – ‘Liver transplant now.’
He returned from Australia in 2010. Then he started performing complex types of liver and pancreas surgery. Slowly getting used to complex surgeries. A liver transplant was not possible with only the knowledge of a one-time fellowship. What next for the first fellowship? Answered the question, but how? The question was not answered. He came back to Australia to find the answer. Only came back in 2015 with answers.
The answer he got was – ‘Liver transplant is very expensive. A team with special training is needed. Equipment is also expensive. Radiologists, anesthesia, nurses also need special training. “Impossible without multi-specialized team and equipment.”
Within this problem, ‘how?’ was the answer. Bhandari started to make a team. It took almost 2 years to prepare the required manpower, training and necessary equipment. Now the set-up is ready for his ambition. He said that the ‘set up’ as per the requirement has been prepared with an investment of more than 12 crores.
According to Bhandari, since the treatment must be done in a private hospital in India, the treatment, which costs more, will now be done by the government here. And that too very cheap. “It is cheaper in Nepal than in India, but there is a fear that not everyone will be able to get treatment,” he said, “because it is expensive.”
For the first time in Nepal, one had to wait for years for a kidney transplant. Moreover, the first transplant failed. Dr. Divya Singh successfully completed the second transplant after 8 years. Bhandari also has a tough start. He is ready to face difficulties. Because he faced no less difficulty in preparing this set up.
Gagan Thapa was the health minister when he planned to launch liver transplants. It was not difficult for him to explain to Thapa because Gagan Thapa was his friend from school, and he knew him well. Along with the implementation of the plan, about 110 million budgets has also been allocated, says Dr. Ramesh in an interview. Therefore, the work of bringing ‘equipment’ to the hospital started. Not much hassle. “If Gagan was not the health minister, it would not have been so easy,” he said.
Although a similar procedure to a kidney transplant, a liver transplant is more sensitive. The risk is the same because the ‘piece of liver’ is cut and transplanted. That is why a ‘multi-specialty’ team is needed in liver transplantation. Bhandari says, ‘It is easier than here because the transplant has been successful before. However, liver transplant is a high-risk transplant not only in Nepal but worldwide.
After starting the liver transplant, he wants to continue. They are not in favor of taking a ‘break’ by doing a transplant. Therefore, even though the setup is ready, they have not started the transplant.
According to Bhandari, his team is performing very ‘high risk’ surgeries which have not been done in teaching hospitals. He is getting along with the team. Where what kind of weakness? It is his initiative to point now. They do not want to make mistakes later. He says, ‘Now the surgery we have done is like playing the SAARC and Asia Cup before the World Cup. The team had to be prepared before playing the World Cup.’
Bhandari connects everything to the game of football. They say that successful transplants depend on team work just like a football game. He argues that just as the teamwork of the keeper, defender, midfielder and forward wins the game, for the transplant to be successful, the teamwork of all the members should be done. ‘A good player can win a game, a good team can win a championship’, he says, ‘I can be good and do one or two surgeries, but a good team is needed for transplantation. And I have that good team.’
Bhandari is no less in sports. He has his own team for futsal. They play futsal matches every Thursday. A football striker during his school days, he still plays the same role. He is a big fan of Cristiano Ronaldo. He never misses a game. As with new research in the medical field, so too in football. He says, ‘If I had not become a doctor, I would have been a player. However, I am in a place to score goals in this field as well. The team believed in me.
Dr. Bhandari said that he had a good relationship with the former Prime Minister as he also worked on kidney transplant of former Prime Minister KP Sharma Oli. He says that the former Prime Minister listened to a song he had recorded while using his mobile phone in the hospital and then he also recorded the song and became a singer.
Dr. Bhandari, who performed the first liver transplant in Nepal, writes on his Facebook.
He feels that the patient’s pressure cannot be sustained after the liver transplant is started. However, he has made his own schedule. A total of 12 transplants in the first two years. Meaning, only one in two months. Doctors say that liver transplant in Nepal costs around 2.5 million to 3.5 million and people from low and middle families cannot afford it, so if the government can provide at least 50% subsidy, it will be easier for the poor to be treated.
The failure of India’s Gangaram Hospital to start liver transplants continues to haunt him. Gangaram’s first 8 liver transplants failed. So the schedule has been prepared. He is also aware that Nepal’s first kidney transplant failed.
“Why should a person who is doing well in liver and pancreas surgery take the ‘risk’ of transplantation?” Having failed transplants in many places, they have learned from the mistakes of others. Even in Nepal, until 10 eggs were transplanted, a team was arranged from outside and for the 11th time, a team of 50 people from Nepal did a liver transplant after spending 11 hours.
‘Learn from the mistakes made by others. Where does one have time to make mistakes and correct them and with us,’ he laughs, ‘and this is the first. First impression is last impression. That’s why there is pressure.’
