Organ Transplantation

In modern medicine the organs that can be transplanted today are; the heart, lungs, heart-lungs simultaneously, liver, kidneys, pancreas and intestines. While the success rate of liver, heart and kidney transplant operations is high in Turkey lately pancreas transplants are also being performed.

In addition to the highly important patient - physician - hospital components, the organ donors are imperative components in organ transplantations. Due to a constant shortage of liver donors and the high percentage of liver disease, the wait period increases each year. Hundreds of people lose their lives annually waiting for livers to be transplanted.

Memorial Hospital Organ Transplantation Center is the first private healthcare institution to be approved and licensed by the Health Department for organ (liver and kidney) transplantation and related laboratory services.

Memorial Hospital Organ Transplantation Center holds a high success rate for performing successful transplantations of liver and kidney.

Liver Transplantation

The most common reason for liver transplantation in adults is cirrhosis. Being mostly caused by Hepatitis B, cirrhosis is a disease in which previously healthy liver cells get damaged. Other conditions known to cause cirrhosis are some congenital diseases and some metabolic diseases.

If someone is unable to continue his/her daily life and activities due to liver failure, then it is time for a liver transplant.

There are different sources of liver donors. Usually the liver is obtained from a cadaveric donor (a person declared "brain dead" but all vital organs and systems are properly functioning). Due to a constant shortage of liver donors and the high percentage of liver disease, the wait period increases each year. Hundreds of people lose their lives annually while waiting for a cadaveric liver to be transplanted. Donor livers can also be obtained from family members or friends who donate a portion of their livers to the patient.

Both blood type and liver size compatibility are essential for liver transplant. It is possible to save the patient’s life by removing a portion of the living donor’s liver and transplant it to the recipient if a family member or a friend is willing to donate a portion of their liver.

A living donor doesn't have to be related to the recipient by blood but the blood type must be compatible. The donor must be in good health and motivated to donate for altruistic reasons. If living donation is a feasible option for the patient, a donor evaluation will be performed after the recipient's testing is completed. After testing the donor, the transplant team decides whether the donation can be performed. Living donors are usually the only chance for children. Ideally, liver transplants should be performed between patients whose blood types are matching. However, in emergency cases it could also be performed between non matching blood types to save the patient’s life. But matching of the liver sizes is a must.

Frequently Asked Questions

What is liver transplant?

It is a surgery where the diseased liver is removed and replaced with a healthy one.

What are the indications for a liver transplant?

The indications for a liver transplant are many types of liver diseases such as cirrhosis, some congenital diseases and liver tumors.

Where do the livers for the transplants come from?

Whole livers come from people who were recently declared dead (a person diagnosed "brain dead" but all other organs and systems are properly functioning). This type of donor is called a cadaveric donor. In order to take the liver from the dead body; this person should have donated their organs or their relatives should agree on donating the organ after death. Organs cannot be traded or sold, it is strictly illegal.

Is it possible to perform a liver transplant from a living donor?

Yes, it is. If a family member or a friend is willing to donate a portion of their liver it is possible to save the patient’s life by removing a portion of liver from the living donor and transplant it to the recipient. A living donor doesn't have to be a blood relative of the recipient but the blood the compatibility of blood types is a must. The donor must be in good health and motivated to donate for altruistic reasons. If living donation is a feasible option for the patient, a donor evaluation will be performed after the recipient's testing is completed. After testing the donor, the transplant team decides whether the donation can be performed or not. Living donors are usually the only chance for children. Ideally, liver transplants should be performed between patients whose blood types are matching. However, in emergency cases it could also be performed between non matching blood types to save the patient’s life. But matching of the liver sizes is a must.

Can any liver be donated to anyone?

No, it cannot. There are certain qualifications in order to safely perform a liver transplant. The donor must be;

• • Have approximately the same weight and body size as the recipient
• • Free from disease, infection, or injury that affects the liver
• • Usually of the same or a compatible blood type

In very urgent cases, liver transplant could be performed between non compatible blood types to save the patient’s life.

Is liver transplant risky?

Yes, it is. A liver transplant is like any other operation, has its own risks that are common to all forms of major surgery. Situations like bleeding, poor function of grafted liver and infections are major risks to occur in the post-op period. Sometimes the new liver does not function as it should and when that happens infections could be a major problem.

What is rejection?

Transplant rejection occurs when the recipient's immune system attacks the transplanted organ or tissue. Human body's immune system protects itself from potentially harmful substances, such as microorganisms, toxins and cancer cells. These harmful substances have proteins on their surfaces that are called antigens. If the immune system identifies antigens as foreign it attacks them.

Foreign blood or tissue can trigger a blood transfusion reaction or transplant rejection and to help prevent this, tissue is "typed" before the procedure to identify the antigens contained.

Though tissue typing ensures that the organ or the tissue is as similar as possible to the tissue of the recipient the match is usually not perfect. No two people (except identical twins) have identical tissue antigens.

Immunosuppressive drugs are needed to prevent organ rejection. Otherwise, organ and tissue transplantation would cause an immune response and result in destruction of the foreign tissue.

The goal of treatment is to make sure that the transplanted organ or tissue functions properly while suppressing the recipient's immune response. Suppressing the immune response can treat and prevent transplant rejection.

Is medication a lifelong affair following liver transplant?

Yes, the patient will have to take antirejection medication for life. Taking medication regularly is essential for a transplant to result in success. If the medication is not taken, the patient’s immune system will immediately recognize the organ as foreign and fight against it. This may cause organ failure or death.

What is the success rate of liver transplant?

The average success rate of a liver transplant is 93.8% in Memorial Hospitals.

Are patients able to return to their normal lives following the liver transplant?

Yes. After a successful liver transplant, most people are able to go back to their normal, daily activities. It is in fact the purpose of the procedure. Pregnancy and child birth are also possible after liver transplant. Most people can engage in physical activity and exercise within a year.

Kidney Transplantation

Kidney transplantation is the best treatment for patients suffering from chronic kidney failure at a terminal stage.

Patients who have lost at least 80% of their kidney functions need hemodialysis or peritoneal dialysis to survive. Dialysis provides life support for many patients however it opens the door to many other problems. The damage it causes on the circulatory system might have negative effect on the patient’s social life. Therefore kidney transplant is the best solution. Kidney transplant improves the patient’s quality of life by ensuring the proper function of the kidney. However kidney transplant is not suitable for every patient with kidney failure. Several examinations and tests must be performed to decide whether the patient is a candidate for kidney transplant.

There are two types of donors:

• • Living donor (from a family member)
• • Cadaveric donor (a person declared brain dead other vital organs and systems are properly functioning.)

It is best to divide donor-recipient matching into three distinct areas; blood typing, tissue typing and cross-matching. Each of these are distinct and important aspects of donor-recipient matching.

Blood Type Matching

The necessities for the basic kidney transplant are very similar to those used for blood transfusions.

There are four major blood types for humans. These are simply noted as blood type O, A, B and AB. In addition to the A and B antigens, there is also a third antigen called the Rh factor. The Rh factor can either be present (+) or absent (-). The factor, however, relates only to a particular cell type in the blood and is not an effector for the kidney. Thus, the positive or negative feature in blood typing is not in relevancy with the matching of a kidney between a donor and a recipient.

A recipient with blood type O can receive a kidney only from a donor with blood type O. A recipient with blood type A may receive a kidney from a recipient with blood type O or A and a recipient with blood type B can receive a kidney from a donor with blood type O or B. Obviously, a recipient with blood type AB can receive a kidney from a person of any blood type.

Tissue Matching

It is obvious that the closer the degree of tissue matching between the donor and the recipient, the longer the transplanted kidney lives. A kidney with a 0 mismatch rate has a 40% more chance for survival (for a 5-year-period) than a 4-6 mismatch kidney. Tissue matching is crucial in cadaveric donors or in the case of transplantation from a relative. However, in alternative transplantation cases (spouses or unrelated donors) tissue matching might not be indispensable since the patient has no other viable choice.

Panel Reactive Antibodies (PRA)

PRA is an immunological test to measure the immune system activity within the body. PRA levels seem higher when more antibodies are being generated. PRA might develop due to pregnancy or previous transplants. The presence of these HLA antibodies must be determined before the transplant can take place. Failing to determine this antibody might result in rejection. It is possible to decrease these antibodies with medical treatment.