Organ transplantation is a miracle that was developed in the last quarter of the 20th century for the human. Organ transplantation is a surgical procedure that aims replacing the dysfunctional organs with other healthy organs. Organ transplantation refers placing a properly functioning organ that undertakes the functions of the dysfunctional organs, such as kidney, liver, heart, cornea, pancreas and small intestines, of the patient. Living donors can be used for kidney and liver transplant surgeries, but cadaver organs – organs of the deceased with documented brain death – are preferred. However, other organ transplantations, such as heart, require donated organs of a deceased with documented brain death.
Organ failure is an insidious disease. Usually, no symptom emerges in organ failure, until the functions of the organ impair by 90 percent. Symptoms of dysfunction are recognized only if the impairment progresses. At this phase, there is anyway no treatment option other than organ transplantation. Although there is a life saving method, namely dialysis, for patients with kidney failure, dialysis can never be a substitute for native kidney. Kidney transplantation implies a 24-hour dialysis, or in other words uninterrupted filtering of the waste substances in the body. Moreover, kidneys have many other functions, such as blood production and hormone secretion, in addition to filtering the waste substances. Therefore, organ transplantation makes a patient healthy, social and productive person again.
Kidney transplant surgery is the gold standard for the management of patients with end-stage kidney and it is the best treatment modality. Kidney transplantation is also the most efficient treatment option to boost the quality of life. Since patients with kidney failure struggle for life while they are connected to a machine for a certain period or may be for many years, they are allowed limited consumption of liquids and solid foods, they are not free to travel and have confined business, family and social life in this regard, they start looking for an appropriate kidney and renal transplantation.
Renal transplantation is a major surgery. The complexity of the surgery arises out of the disease of the patient rather than technical challenges of the operation. Dialysis patients are at higher operative risk in comparison to a healthy person. However, maintaining the dialysis is associated by more and/or higher risks. Since living donor transplantations are elective surgeries, the patient is very well prepared for the operation. Therefore, the operative risk is very low. No death is encountered in transplantation surgeries carried out by our team. The one-year success rate is 99.9% approximately for 2000 transplant surgeries performed in 26 years.
Living donors are very important for us. They agree undergoing a surgery to save life of their loved ones. Therefore, they should not face damage due to this surgery throughout their remaining life in against for this generosity. Donor subjects are screened in detail in our Kidney Transplantation Center, before the transplant surgery is decided. Since we could detect other diseases in very early phase in the screening, we could cure the diseases of donor candidates before it is too late. There are many examples of this fact. Patients might have get the opportunity to save their lives, as colonic, prostatic, renal or gastric cancer can be diagnosed in early stage, when they are examined for the organ donation. This is not only limited to cancer; certain diseases, such as diabetes mellitus, hypertension and tuberculosis, are also diagnosed in this detailed examined, before they could not harm the body.
In case of even a minor suspicion, the donor candidate is excluded. The donation can be accepted only if they are very healthy and will also be healthy, after they donate a kidney. A Swedish study demonstrated that the kidney donors live longer. Undoubtedly, the finding is based on the fact that they are already very healthy and the kidney donation does affect their lives rather than donating a kidney.
The donor and the recipient should do what healthy people routinely do after the operation. Exercise, consumption of fluids abundantly, avoiding weight gain, eating salt-free foods and quitting or avoiding hazardous habits, such as smoking. Moreover, the recipient should take medicines, as instructed, and present for follow-up consultations at regular intervals.
What are treatment methods for end-stage renal failure?
End-stage kidney failure implies that the kidneys have lost more than 90% of the functions. In this case, some treatment methods are required to substitute for the functions of the kidneys. Undoubtedly, patients with renal failure are luckier than other patients – a case of lesser of two evils. Because the patients with dysfunction of other organs, such as heart and liver, have no chance like dialysis. If an appropriate organ cannot be found, those patients die within a short period. On the other than, one of the dialysis methods can keep the patients with kidney disease alive. These dialysis methods include hemodialysis, where patients are connected to a machine for four hours per session usually in 3 days of week, and peritoneal dialysis, where a tube is inserted into the abdominal cavity and the dialysis fluid is instilled and aspirated. Or, those patients will undergo renal transplant surgery that is globally recognized as a modality superior to these dialysis methods in all aspects.
What are superiorities of kidney transplantation?
These patients can resume a routine life just like healthy people after the kidney transplant surgery, and their life span is comparable to that of the healthy people. Kidney transplantation offers a higher quality of life relative to the dialysis methods. Moreover, the limitations imposed on food consumption and travel are also eliminated. Those people can start working and get the position of producer by leaving the status of consumer behind. They can start a family. Since dialysis reduces the reproductive capacity of both women and men, the transplantation can also restore the capability.
The base of the kidney and organ transplantation is transferring the donated organs of the deceased with documented brain death. Since this type of transplantation is very limited around the world and in our country, the living donor transplantation has come to the forefront. However, blood type compatibility is a must for the kidney transplantation. Since transplantation from a donor with blood incompatibility is not legal in our country, cross transplantations that are first carried out by our team in our country are a remedy for this problem.
What is cross transplantation?
Two patients with living related donor cannot undergo kidney transplant surgery due to ABO incompatibility or in other words, incompatible “cross-match”. Those two families are met and the donors of the patients are crossed, provided the surgery is concomitantly performed for both donors and patients. In other words, the kidney of the Donor A is transplanted to the Recipient B, while the kidney of the Donor B is transplanted to the Recipient A. In this way, health of both patients is restored.
Cross transplantation was first performed in Korea. Later, it gained popularity around the world. Currently, it is performed in Scandinavian countries, Belgium, Canada and the U.S. This method is first employed by the members of our Organ Transplantation team in our country. First appropriate families are identified and introduced to each other. This will certainly require positive communication. If a positive communication between the donor and the recipient couples fails, the procedures are explained in detail to them and next, medical procedures are started. If medical examinations do not demonstrate a condition that contraindicates kidney transplantation, both recipient surgeries are started concomitantly; donor kidneys are removed, relatives are crossed and the surgery is completed. The kidney transplantation team of Okan University Hospital is also first in our country to cross three and four donor and recipient couples in addition to crossing two donor and recipient couples.
Advices For Renal Transplantation Candidates
Each dialysis patient dreams of a kidney transplant surgery. Since patients with kidney failure struggle for life while they are connected to a machine for a certain period or may be for many years, they are allowed limited consumption of liquids and solid foods, they are not free to travel and have confined business, family and social life in this regard, we take a huge responsibility by conducting a living donor-based program by this necessity in order to help such patients. Although kidney of a living donor is preferable for the recipient, we, the organ transplant surgeons, face a tremendous responsibility by carrying out two operations rather than one surgery and operating on a person, who makes a great sacrifice in order to save life of a loved one, although s/he has no disease.
Irrespective of a living donor or cadaver donor transplantation, all the necessities should be fulfilled for the perfect result of the kidney transplant surgery. Therefore, all people should be very sophisticated, who are involved in the transplant procedure. A strong, wise and experienced surgical team requires a nephrology group that cooperates with the team in the field of the kidney transplantation. Since there are such quality teams in our country, the patient should take care of experience and harmony of the surgical team in addition to the members of the team. This team should be organized to deal with patients round the clock. Organ transplantation is not a single-surgeon operation. Moreover, organ transplantation does not imply only the treatment carried out by the surgical team. It requires contribution of all physicians from other departments of the hospital. The service spectrum of the hospital should be inquired, ranging from cardiology and interventional radiology to the infectious diseases medicine and urology.
Cadaver Donor Transplantation
Although organ transplantation primarily reminds us the transfer of organs donated after brain death, this type of organ transplantation is, unfortunately, very scarce in our country. The donation after brain death is around 25 to 30 per one million people in western countries, this figure, recently, reached 4 per one million people in country based on the recent efforts of our Ministry of Health. As a result, cadaver donor transplantations account for 70% of kidney transplantations in western countries, where the figure is around 20 to 30 percent in our country, although it varies by years.
Since family bonds are strong in our country, family members voluntarily present to donate organs to their loved ones, when they witness the conditions of life their loved ones survive. Although living with a single kidney has no drawback, this procedure requires tremendous physiological and psychological sacrifice. Depending on the principles of not hurting the donor, the donor surgery is also very distressing for us, the surgeons. Whereas hurting a person with brain death is not the case, although we strongly respect them and carry out the surgery very carefully. Removing the organs that will rot in the ground and saving life of minimum 5 people with those organs are far less stressful than living donor surgeries.
More than 3 thousand kidney transplant surgeries are carried out every year in our country. Any and all novelties and modifications are put into force that are required for living donor transplantation. Laparoscopic nephrectomy (removal of kidney) and cross transplantations are some examples. Laparoscopic donor nephrectomy is also first carried out by our team in our center. This approach shortens the recovery period for donors.
Experienced teams work in the intensive care unit of our hospital and all staff are very aware of organ donation. Our organ transplantation coordinator discusses with family members of patients, who are diagnosed with brain death in our intensive care unit, and our rate of consent for organ donation is strikingly high. These advantages are also offered to our patients who are waiting on our cadaver list. Three patients took this advantage within one year and they got healthy again. Since our cadaver organ list is not too long, the citizens registered on this list have relatively higher chance for the cadaver donor transplantation.