Dialysis and kidney care in Bhutan

Dialysis and kidney care have become a growing part of Bhutan's public health system as the number of people with kidney failure has risen: in 2014 Bhutan had 137 patients with end-stage kidney disease on treatment at three hospitals with 14 dialysis machines, and by August 2026 there were 478 patients on haemodialysis at eight centres across the country.^[1][2]

For decades the main hope for patients was a kidney transplant abroad, usually in India, paid for by the government. Bhutan carried out its first transplants at home in September 2023, and in August 2026 it introduced peritoneal dialysis, which patients can do at home.^[3][2]

Causes

In 2014 Health Minister Tandin Wangchuk called kidney disease a "silent killer" that was growing every year, and linked it to diabetes, high blood pressure, smoking and obesity. Annual health bulletin figures he cited showed recorded diabetes cases rising from 2,541 in 2008 to 4,097 in 2013, and hypertension cases from 20,347 to 27,023. The Bhutan Kidney Foundation said at the time that 98 per cent of its kidney patients came from rural areas.^[1]

Haemodialysis

Haemodialysis, in which a machine filters the blood in sessions of up to four hours, usually twice a week, has been the main treatment for kidney failure in Bhutan.^[2] It was first concentrated at the national referral hospital in Thimphu (JDWNRH) and the regional referral hospitals in Mongar and Gelephu.^[1] In 2023 more than 180 patients were having dialysis at two centres in Thimphu, and Thimphu Thromde began giving free city bus cards to some low-income patients after the Bhutan Kidney Foundation asked for help; patients said a taxi to hospital cost Nu 160 to 200 (~USD 2) each way.^[4]

Many patients have had to move to, or travel long distances to reach, a hospital with a dialysis unit. In eastern Bhutan, the Bhutan Kidney Foundation counted 188 patients on dialysis, most of them treated at Mongar, which had four machines in operation. The Ministry of Health then designated Trashigang Hospital as the main dialysis centre for patients from Trashigang, Pemagatshel, Samdrup Jongkhar and Trashi Yangtse from the 2025–26 financial year, citing the high disease burden and the two-and-a-half-hour journey to Mongar.^[5]

The Trashigang unit opened in 2026 and serves ten patients from Trashigang, Trashi Yangtse and parts of Mongar. By November 2026 its dialysis was being disrupted by repeated breakdowns of the reverse osmosis machine that purifies its water, which the hospital put down to poor water quality and ageing equipment; patients had to travel to other hospitals when it failed. The hospital had secured World Bank-assisted funding for a dedicated water treatment plant, with equipment expected in December 2026.^[6]

Peritoneal dialysis

In August 2026 the National Medical Services and JDWNRH launched Bhutan's first peritoneal dialysis service. The method uses the lining of the patient's abdomen to filter waste, and eligible patients can do it at home after training, which cuts the number of trips to a dialysis centre. Doctors and nurses from JDWNRH trained at Siriraj Hospital in Thailand, a patient handbook was published, and the service is to be extended gradually to all 20 dzongkhags.^[2]

Transplants

Before 2023 every Bhutanese kidney transplant was done abroad. Between 2006 and 2014 the government paid for 83 transplants at a cost of nearly Nu 59 million (~USD 690,000).^[1] Patients who cannot find a compatible donor stay on dialysis: at the end of 2024 the Bhutan Kidney Foundation counted more than 411 people in that position. The Ministry of Health was then drafting a revised referral guideline that would allow transplants between donors and recipients of incompatible blood groups, which until then had been done only in India at Kolkata or Vellore, and would raise the daily allowance for patients and escorts to Nu 400 (~USD 5).^[7]

The first transplants in Bhutan took place at JDWNRH on 18 and 19 September 2023, carried out by Bhutanese doctors with a team from Rajavithi Hospital in Bangkok. A 34-year-old woman received a kidney from her 26-year-old sister, and a 26-year-old woman received one from her 40-year-old brother. About 375 patients were on dialysis at the time. JDWNRH nephrologist Dr Minjur Dorji said the hospital hoped to perform transplants without outside help within one and a half to two years.^[3] See also Bhutan–Thailand relations.

Bhutan Kidney Foundation

The Bhutan Kidney Foundation, registered in 2012 and founded by Tashi Namgay, supports patients and campaigns for awareness and early testing. It helps patients find donors, runs transport for some, and has pressed for dialysis services closer to patients' homes.^[1][4][5]

See also

• Healthcare system of Bhutan
• Jigme Dorji Wangchuck National Referral Hospital
• Mongar Regional Referral Hospital
• National Medical Services

References

1. Tashi Deki, "Chronic Kidney disease, a growing problem in Bhutan: health minister". The Bhutanese, 15 March 2014.
2. "Bhutan introduces Peritoneal Dialysis Service". The Bhutanese, 15 August 2026.
3. Tshering Dema, "34-year-old and 26-year-old kidney recipients and their donors recovering well in first kidney transplant surgery in Bhutan". The Bhutanese, 23 September 2023.
4. "Thimphu Thromde provides free city bus service to kidney patients". Bhutan Broadcasting Service, 2023.
5. Kezang Choden, "Trashigang Hospital Designated as Main Dialysis Centre for Eastern Bhutan". Bhutan Today.
6. "Frequent breakdowns of dialysis machine disrupt treatment in Trashigang". Bhutan Broadcasting Service, 4 November 2026.
7. Nidup Lhamo, "Draft guidelines to ease kidney transplantation". Business Bhutan, 28 December 2024.