Many organs need to function harmonically in order human organism to work perfectly. Some of these activities are as follows: the heart pumps the blood; the lungs transport oxygen (O2) into bloodstream and release carbon dioxide (CO2) from the bloodstream; the kidneys filters toxic and waste materials in the body; and the liver performs a large number of biochemical reactions as a central laboratory.

These and many other organs try, in harmony, to keep the human alive, in other words our brain. Although our brain is like a main control center, in fact all these organs perform a large part of their functions alone. Namely, all has a common form of activity for human organism as well as a separate life on their own.

The diseases occur when any of these organs dysfunctions. When dysfunction becomes not treatable or reversible, this means that the life is at risk and the life gradually ends as loss of function progresses.

An individual in this stage needs a new organ to be able to continue his/her life. If the needed organ is a kidney then you may need to spend rest of your life connected to a dialysis machine; or if the organ with failure is heart or liver then the human life is under a serious threat. All these patients may loose their life if an organ is not found on time.

The organ transplant is the only treatment method in the world for survival of these patients. Although some genetic studies or researches e.g. stem cell transplantation are at full speed, it remains uncertain how they would affect the treatment programs.

No! Organ transplantation is based on tissue and organ match. Just as blood of someone cannot be transfused to someone and the blood type is important, the same thing applies to the organ transplantation. Because match criteria can vary by the organ to be transplanted, the transplanted person, that is, the body of “recipient” will detect the organ as a foreign body and eventually reject it, if such principles are not considered.

With use of immunosuppressive drugs in the medicine particularly after 1960s, transplantation practices have currently been accelerated. Despite match of any tissues identified, the body tends to recognize and reject the foreign organ for many factors we currently don’t know. The immune system is deceived in some way by these drugs, and the organ is intended to live. Nevertheless, these drugs do not fully eliminate the requirement of tissue match. Therefore, for a successful transplantation, both compatible organ and a conscious immunosuppressive are essential.

No, they may not. When organs of a deceased person are donated, a coordination system is activated. As required by this system, donated organs are first reported to Regional Coordination Center (RCC) of Health Ministry then to National Coordination Center (NCC). Distribution of the organs is determined by these reports. Such donated organs are national wealth and can be transplanted into a person considered suitable by the system. In such system, an organ of someone cannot be sold to anyone without knowledge of relevant person.

System is too complex to be released from self-control and involves a crowded team. There are too many people in the system to cover up a possible sale. Thus, it is out of question that deceased organ donations in particular may actually be abused. Hence, there are no incidents recorded in the judicial files. The abuse of living donor transplantations may not be covered up either. In such cases, the gaps in the legal system are exploited as anyone knows.

Such information is never enough for transplantation. It only contains several identification data indicating the intent of the person but not his/her health condition.

As the name implies, one refers to life while the other refers to death. Persistent vegetative state, as is evident from its name, is a life like a plant but the person is not dead. The brain functions are impaired. Although they lie down as if they were dead, they are completely alive and may recover and get up in years as a miracle. The brain death, on the other hand, refers to total and definite death and the death is an irreversible concept as we all know.

Such organizations, called in the west as “Donor Action”, are established for increasing the availability of cadaveric organs in the country.

It is not only our problem but also a global problem to be unable to perform transplantation due to lack of organ. However, this problem can be unfortunately called a disaster considering some aspects. Currently, the number of cadaver donors per million population ranges from 35 to 55 in European countries while this figure is under event 1 in the country. This also indicates how far we are from the solution.
Therefore, studies on establishing organizations have been initiated in the country, following the western examples. The goal here is to save hundreds of lives that have to end waiting for an unfound organ.

The life of organs and humans is different from each other. When patients lose one of their vital organs because of a chronic disease, they may stay alive only for a short time if this organ is not brain. The only way to save them in this short time is organ transplantation. The diseased organ is replaced with a health one so that the patient can get back to their healthy life. When it is not possible to find an organ, such patients eventually die. Although the patients with renal diseases are possible to live by dialysis machine, life of these patients, whose life is already hard, is significantly short. It is almost impossible to encounter such a case contrasting as day and night in any fields of medicine. The patient will be fully healthy if the transplantation is successful but if not, the patient will die which only happens in the organ transplantation.

Do the family members or the state reimburse the hospital expenses of a patient who is announced as brain death in the intensive care and whose organs are donated by the family but who do not have a social security? Does the family receive any money?

No sufficient laws are available on this issue. There are still some hospital administration-related problems with expenses of donors. Although the general practice is to clear off donor’s expenses by hospital administration after donation, there may be problems in practice. It is because this is based on good faith rather than on the rules. The family of the donated patient never receives any money.

Removal of an organ from the cadaver is performed with due diligence as much as a living surgery.

After removing the organs, great attention is paid not to damage the deceased in any way, using aesthetic stitches if possible. The corpses are sacred to physicians who gratefully appreciate these corpses that deserve significant respect.

No, there isn’t. Although the age of the donor poses some risk with respect to the organ to be used, it is possible for recipients, whose disease is too progressed to allow them live tomorrows, to use any organs of any ages.

Yes. All you need to do is to tell your family who will consider your donation when time comes. Your organs may not be removed unless your family permits even if you have donation card.

Currently, the major organs such as heart, lungs, intestines, pancreas, kidneys, and liver can be successfully transplanted globally. In addition, there is a wide area of tissue transplants including bone marrow, cornea, bone and tendon. In the nationwide, major organ transplantations include the heart, liver, pancreas, and kidneys which is very common and successfully performed.

You will never experience such a thing. Saving the patient life is primary. The physician and staff admitting the patients in emergency services have nothing to do with the organ transplantation team. The mission of this team is to save the patient life. They work as a crowded team and team members are aware of the activities of the others. The organ transplantation team is informed by an activated system when a patient dies. This team may not do anything if the patient is not dead. Since the family consent is required for organ removal, the family may not donate the organs if they are not satisfied with the treatment.

You may definitely donate your organs. Although deceased organ transplantations are more appropriate, a considerable number of living donor transplantations nationwide has resulted in a considerable experience. In this sense, the rate of experiencing a health problem among those who have donated one or more organs to the family is very low.

The organ transplantations in our country are performed at global standards and even beyond the global standards. The success rate of major organ transplantations, e.g. the liver and kidneys, is greater than 90%.

“Whether organ donation is a sin” and ”Whether the donor would be held responsible if the transplanted person lived his/her life as a bad person” are the questions that are frequently asked at organ transplantation centers.

The answer to this question by Prof. Mehmet Bayraktar, Member of Religious Affairs Higher Council at the Department of Religious Affairs and Academic at Theology Department in Ankara University is as follows:
-”Islamic religious approves organ donation. Maide sura says: ‘Whoever resurrects an individual, he/she resurrects all humanity.’ So, we can say that those who donate their organs to save others would acquire merit. Furthermore, a sin is committed by humans not by organs. The sin is attributed to the person not to the organ.’ ‘(SBK – The religion is related to mind as we all k now. An unconscious individual cannot commit a crime. The transplanted organs between people belong to the body which is a type of dress. It remains in the world. Just as a beggar or dependant person accepts some alms and then the alms is his/her responsibility, the sin or merit belongs to the person who carries the mind. Given that a gun would not be accused of killing someone, the earthly body, in other words the dress cannot be held responsible. It is just a present you give away. A possible future sin will only and merely belong to the one who has accepted and used the present.

The organ needed for liver transplant comes from the deceased donors with brain death or living donors with a part of the liver removed.

The transplanted liver is a “foreign” tissue either from a deceased donor or a living donor. Therefore, the transplanted persons need to use some immunosuppressive drugs for a lifetime to prevent the transplanted organ from rejecting. However, organ rejection-related deaths are rare due to adaptation of the liver.

A major group of drugs to be used after a liver transplantation is the immunosuppressive drugs to prevent organ rejection. The risk of organ rejection is the highest in the early post-transplant period but diminishes in time. Thus, immunosuppressive drugs are prescribed in higher doses in the early post-transplant period but often reduced to very low dose or one drug in years. However, the transplanted person must continue to take regularly the immunosuppressive drugs throughout their life. Because of the risk of infection in the early period associated with using high dose of immunosuppressive drugs, prophylactic antibiotics should be periodically used against common infections during the first year of surgery. There are groups of drugs that interact with immunosuppressive drugs that are particularly used after transplantation. There is also a group of drugs that may increase possible toxic effects of immunosuppressive drugs on the kidneys. Thus, any drugs, other than those indicated by organ transplantation team, should be first consulted to liver transplantation team then used after liver transplantation.

The volume of the liver to be removed from the living donor is determined by the body weight of the recipient. The required volume is usually one percent of the body weight. So, approximately 700 g of liver is needed for a patient who weighs 70 kg. The weight of the liver is about two percent of the body weight in a healthy person. The weight of the liver is about 1400 g for a donor who weighs 70 kg. The liver is consisted of two lobes, right and left lobes. The right side consists of two third of the liver whereas the left side consists of the one third. Thus, the liver’s right lobe of the living donor, i.e. approx two third of the liver, is removed to obtain adequate volume of liver in adult liver transplantations.

It is know that the living liver donors are at risk of death by 0.2-0.5%. In other words, it will be 99.5 -99% successful. Also, about 15-20% of living donors may develop “simple” complications that prolong duration of hospital stay and require a drug therapy and about 5-10% of them may have hemorrhage, bile leakage, ascites, and hydrothorax which might require additional interventions. However, the studies based on long-term follow-up report that the donors do not usually have any problems later in their life associated with the liver transplant surgery. Almost all liver donors give a positive answer to the question “Would you consider donating your liver again if you had the chance to go back in time?”

It is know that the living liver donors are at risk of death by 0.2-0.5%. In other words, it will be 99.5 -99% successful. Also, about 15-20% of living donors may develop “simple” complications that prolong duration of hospital stay and require a drug therapy and about 5-10% of them may have hemorrhage, bile leakage, ascites, and hydrothorax which might require additional interventions. However, the studies based on long-term follow-up report that the donors do not usually have any problems later in their life associated with the liver transplant surgery. Almost all liver donors give a positive answer to the question “Would you consider donating your liver again if you had the chance to go back in time?”

The recipients are usually discharged 2 weeks after the surgery. Because of the immunosuppressive drugs given in higher doses in the early period, the risk of infection is particularly higher in the first 3 months. The incidence of early post-transplantation surgical complications is the highest in this period. The patients often can get back to working life and normal social life in 3 to 6 months.

The most common risks after liver transplantation include surgical complications and infections such as hemorrhage, bile leakage, and atherosclerosis. In the long-term, cancer development, organ rejection and bile stenosis may occur. Approximately, one patient of 10 dies early post-transplantation period.

The survival rate for one year is around 85-90% at successful centers. The survival rate for five years is 70-75%. Contrary to kidney transplantation, there is no life expectancy for a transplanted liver. The compatibility of liver with the recipient can be achieved in the long-term by using immunosuppressive drugs in very low doses. The life expectancy after 5 years is usually determined by the patient general health condition, and concomitant health problems such as cardiac diseases, and diabetes.

There are 2000 to 2500 people that will need a liver transplantation each year in Turkey. Yet, the number of surgeries is about 700 a year. Of these surgeries, 250 are performed with a cadaver and the rest is performed with a living donor.

The surgery takes 4 to 6 hours when performed with donors with brain death and 8 to 10 hours when performed with a living donor. The patient will usually stay in the intensive care unit on the date of surgery and the next day then be transferred to the patient room.

The checks are performed twice a week for two weeks after discharge; once a week by the 3rd month of transplant; every two weeks between the third and sixth months, and then monthly. After a year of transplantation, the patients are monitored half yearly or annually by the recipient characteristics. The follow-ups include examining the patient, routine biochemical tests, and radiologic imaging if required.

To be a living donor in Turkey, there must be a blood relationship of fourth degree between the donor and recipient. Therefore, a birth certificate is required by transplantation centers and needs to be confirmed by the chief physician. In case of a non-kin living donor, a central Ethics Committee, which is established by the Ministry of Health and conducted periodically, evaluates the application by the transplantation center.

What tests will recipients and donors undergo?

For liver transplant recipients, the tests are performed for risk of infection in addition to biochemical and radiological imaging, and they are evaluated by the specialists in cardiac and chest diseases. For living donors, a series of biochemical tests is performed; a Computerized Tomography is performed to determine vascular structure of the liver and calculate the volume of the liver; a Magnetic Resonance is performed to evaluate biliary tract, and a liver biopsy is performed to investigate fatty liver if necessary.

A cadaver is a “dead person” who is diagnosed with “brain death” by relevant physicians during follow-up in the intensive care unit, and who is deemed suitable by Organ Transplantation Coordination Center for use of his/her organs. A cadaver list is a waiting list in which suitable persons for organ transplantation are listed by a score they receive according to their condition. To establish this list, an application needs to be made by any transplantation centers to the Ministry of Health.

The inspection of cadaver lists by Ministry of Health was initiated in 2010, and there are no official statistics about waiting period. However, given that the number of organ donations per million population in Turkey is only one tenth of European and American average, the average waiting period is estimated to be 2 years.

How an organ is removed from a cadaver? Who is prioritized by what? What is the waiting period for a removed organ?
After obtaining relevant permits, the organs of a donor with brain death are removed by a transplantation team formed by National Coordination C enter (NCC) for Organ and Tissue Transplantations. The priority of organs is decided by NCC in consideration of patient score in the National Coordination C enter for Organ and Tissue Transplantations. Although a removed liver should ideally be transplanted in the first 12 hours, this can be up to 24 hours which is an acceptable limit.

According to Laws of Republic of Turkey, a patient may enter a waiting list of liver transplant via National Coordination Center for Organ and Tissue Transplantations after application of licensed centers of liver transplantation. A patient may only enter the list of one transplantation center.

Whether the organs of donors with brain death can be used is decided by the National Coordination Center for Organ and Tissue Transplantations after confirming the report of brain death and obtaining consent of the family by organ transplant coordinators. The liver is given to a patient with the highest score which is determined by the transplantation list. The relevant transplantation center will then decide whether the given organ is suitable.

No, they don’t. The evaluation of an organ removed from a donor with brain death approved by National Coordination Center (NCC) for Organ and Tissue Transplantations is made by the center that will use the organ; and it is the same center that will decide whether the organ is suitable for the recipient.

It is possible to achieve a gestation and healthy delivery after liver transplantation. However, the risks include the low birth weight, preterm delivery, and miscarriage. There must not be any problems with the liver or other organs before gestation, and the patient must have not experienced an organ rejection in a year. For pregnancy after liver transplantation, the patients need to have at least 1 year or 2 years ideally without any problems. The pregnant patients need to keep in touch with the organ transplantation team during the pregnancy.

Vital functions of the patient are constantly monitored by the anesthesia team during the surgery. The duration of the surgery does not pose a risk for other organs.

The patients are postoperatively fed orally in the earliest period possible, and their daily caloric requirement is decided by a dietician. The important thing in the long term is to apply a diet regimen to keep patient’s blood pressure, blood glucose and cholesterol at a normal level and to prevent excessive weight gain which is very common after the transplantation.

An exercise program applied by performance state after a liver transplantation will be useful to deal with muscle weakness and bone loss caused particularly by chronic liver failure and cortisone. It will also be helpful to avoid excessive weight gain which is very common after a transplantation.

No. Alcohol is very toxic to the liver and interacts with immunosuppressive drugs used after the transplantation. Furthermore, it is reported that return to alcohol intake will shorten the lifetime in those who have undergone a liver transplant surgery for alcohol-related hepatic cirrhosis.

Yes. The compliance with the drug therapy and whether adequate family support is provided are definitely evaluated in either living donor or cadaver donor liver transplantations. The liver is not transplanted in case of active substance addiction, mental retardation, and severe psychiatric disease.

The patients can return to normal sexual life a short period after the transplantation. Impotence and lack of sexual drive associated with chronic hepatic disease improve after the transplantation but it will take time for libido to recover.

Yes. The risk of skin cancer increases after liver transplantation. Since the risk of cancer gradually increases in years, protection from the sun is necessary at all times. Therefore, long-sleeve clothes and a hat should be used to protect against direct sunlight. In addition, it is important to use high-factor sun creams and have regular skin examinations. Patients can swim after all drains and catheters are withdrawn and the surgical site is recovered. However, you should choose well chlorinated swimming pools and seas with clean water certificate, and protect yourself from the sunlight.

Yes. The risk of infection associated with the immunosuppressive drugs used after the transplantation is higher especially in 3 to 6 months. It is important to get in the habit of hand wash and avoid persons with influenza. The risk of infection reduces in later periods with reduced immunosuppressive drugs.

After a liver transplantation, the surgical site heals without leaving a bad scar. Depending on the features of immunosuppressive drugs, wound healing is usually normal, and it is possible to have a plastic surgery for both surgical scar and other parts of the body.

How many days would be needed to have a bath after the transplantation?
The patients can have a bath on the 3rd-4th day of IV catheter removal after the transplantation.

Globally, the age of 70 years is usually considered to be the upper limit for liver transplantation. Living or cadaver liver transplantations are successfully performed in our country, in the world, and at our center.