Both living and deceased donor organ donations and transplant activities are regulated by relevant departments of Ministry of Health in our country. Transplant centers are audited and licensed by the ministry. Doctors and teams with history of very specialized educations and documented experience are licensed. The healthcare facilities licensed by the ministry admit patients, who require organ transplantation, and record them in National Organ Waiting List.

For example, if family member(s) donate(s) kidneys of the patient who dies in intensive care unit of any hospital in our country, the donation is immediately notified to the ministry. Next, the ministry identifies the most appropriate patient for the donated kidney. Here, a very detailed review is made to be fair. Among all patients with blood type same with the donor, the patient with highest score according to certain criteria, such as tissue compatibility, age, duration of dialysis and the time elapsed in the waiting list, will have a lucky break. This approach is not only fair, but it also increases the success rate of operation. The organ is transplanted to the patient, if 100% tissue compatibility is reported for the patient.

Transplant centers review whether the organ will function or not, if the donated organ is transplanted. If it is decided that renal functions will be restored for the benefit of the patient, the kidney of the deceased donor is surgically removed and transplanted to the patient in the transplant center.

Organs of the deceased donor are very carefully removed in the operation. The bodies of organ donation are blessed for the organ transplant doctors, who know that organ transplantation is a miracle and patients can be survived with these organs. This operation is performed very carefully and respectfully, as is the case with a living human. On the other hand, the donated organs should be very carefully and properly removed in order to protect the organ and successfully transfer it to the patient.

 

ABSTRACT

“The deceased donor kidney transplantation” implies transferring the kidney donated by patients, who are diagnosed with brain death despite all efforts while treatment is maintained in the intensive care unit, to another patient with a kidney disease, who needs the transplant kidney.

First, some procedures need to be performed to remove the kidney from the deceased donor. It is very important to maintain the blood circulation to avoid damage to the organs of the deceased body. Therefore, mechanical ventilation and critical care should be maintained for the deceased body. Thus, respiratory functions and blood supply to the organs can be sustained. Next, kidneys are removed and stored in a cold environment.

Removal of organ from a deceased donor is performed as meticulously as an operation for a living donor. The most aesthetic sutures are placed after organs are removed and all measures are taken in order not to injure the deceased body. Those bodies are deemed blessed for doctors who know the value of organs very well and believe that they deserve a very heartedly respect. 
 

Who can be a donor?
 

1. Requesting to be an organ donor after death:

First, the patient should be at least 18 years old to make this decision. If a person decides to donate organ after death, s/he may visit any healthcare facility to meet this desire. Authorized persons will record you over “Transplantation, Dialysis and Monitoring Systems” (TDIS) of the ministry and you will be delivered a card that shows you are an “Organ Donor”.

You can also communicate your request over “E-nabız (E-pulse)” system to have relevant persons contact you. According to the relevant legislation in our country, consent of the family members is requested irrespective of prior organ donation declaration of the deceased person. If a person dies who has donated organ to be used after his/her death, the consent is necessarily obtained from family members. If family members of an organ donor refuse the organ donation, the organ cannot be donated.

2. Organ donation by patients who die in the intensive care unit:

Family members are contacted for organ donation, if the organ is donated by a patient, who dies in the intensive care unit usually due to head trauma, cerebral hemorrhage, ballistic trauma, certain infections and brain tumors despite all procedures and efforts.

Undoubtedly, the decision is left to the discretion of the family members. Ability to make this glorious decision by persons, who have lost a family member very soon, despite insufferable sorrow, implies a gift of life for patients who are hopefully waiting in the waiting list. Such a donation can be the case for any range of age.
 

How is deceased donor transplant surgery performed?

For the deceased donor kidney transplantation, you need to be recorded in National Organ Waiting List of the Ministry of Health. In this end, you need to first contact an organ transplantation coordinator of an organ transplant center. The procedures will be facilitated in the first contact, if you bring results of previous tests and investigations.

Organ transplantation coordinator will primarily organize your visit to and examination by a nephrologist and surgeons from the kidney transplant team. Necessary tests and investigations are planned according to your general health condition and the disease and next, appointments will be scheduled for blood tests, HLA tissue group, PRA (Panel Reactive Antibody), radiology studies and required consultations (cardiology, pulmonary medicine, and also gynecology and obstetrics for female patients).

Preparatory procedures may vary depending on the health condition and other patient factors. Here, the important point is to prepare you for kidney transplantation in all aspects and to reveal out all risks concretely. If you are found eligible for the deceased donor kidney transplant after you are discussed in the Kidney Transplant Council, you are recorded in the National Kidney Waiting List.

Waiting List and the deceased donor organ transplantation are organized by National Coordination Center that is affiliated to the Ministry of Health. Regional Coordination Centers available in 9 cities of the country (Adana, Ankara, Antalya, Bursa, Diyarbakır, Erzurum, İstanbul, İzmir, Samsun) operate in affiliation to National Coordination Center.

When a kidney is donated by the deceased donor in a hospital, this issue is notified by organ transplant coordinator to the National Coordination Center through the regional coordination center. According to the criteria set by scientific committees, the donated kidney is matched with the patients recorded in National Organ Waiting List. Most significant criteria for this match are blood type, tissue group match, age, duration of dialysis and the time elapsed in the waiting list.

National Coordination Center is primarily listing the patients who reside in the region, wherein the kidney is donated. When the list is finalized, the patient who is listed on top and meets most criteria is notified to the center, wherein the patient is recorded, in order to have the kidney transplanted.
 

What will happen when I am admitted for organ transplant?

If you are admitted for transplantation from a deceased donor, this means that you are one of the patients with highest scores in donor organ distribution system of our country. In this case, the organ transplant center, wherein you are recorded, have assessed both the donated organ and your health condition and contacted you, as no contraindication for transplantation could be found in the light of up-to-date literature.

At this stage, you are asked to visit the hospital, where you have presented for transplantation, as soon as possible. Once you are admitted to the hospital, certain tests and investigations will be started to ensure that you do not have a condition which may contraindicate the surgery. Infection tests, detailed blood tests to evaluate organ functions, chest X-ray, and tomography are requested and you are consulted with nephrology, surgery, cardiology, and anaesthesiology clinics as well as other relevant departments. Moreover, cross-match and PRA tests are analyzed on the donated organ and your blood samples.

If no negative condition is found in all these tests, surgery process is started.
 

How is my care maintained in waiting period?

Each facility may have different protocols to follow the patients recorded in their lists. Physical examinations, jaundice tests, detailed biochemistry profile, routine cancer screening (PSA, Pap smear etc.), radiology studies, cardiac examination (ECHO, stress test, myocardial perfusion scan, coronary angiography, if necessary), tests specific for the condition of patient and PRA analyses are repeated regularly. Here, the important matter is to make the patient wait in the most appropriate condition for a possible kidney transplant. When you are admitted to our facility for kidney transplant surgery, all above mentioned tests can be repeated within several hours and whenever needed.

The patients waiting in the organ transplant list are recommended not to have blood or blood product transfusion unless it is critically necessary. You should necessarily inform your organ transplant center, when you are transfused blood for absolute indications. PRA tests should be repeated at least 3 to 4 weeks after the transfusion for patients who are transfused blood. 
 

What are advantages of having a living donor?

Approximately 25000 people are waiting for kidney transplantation from deceased organ donor in Kidney Waiting List of our country. Approximately 1000 deceased donor kidney transplant surgeries are carried out per annum. Roughly, the chance of undergoing renal transplant surgery is 1/25 or 4 percent for a patient in one-year period. Since donor organs do not meet all needs, Transplantation, Dialysis and Monitoring System (TDIS) of Ministry of Health acts in accountable and transparent manner in order to ensure these precious gifts are transplanted to appropriate patients.

There are certain criteria for patients waiting in organ donation list, such as blood type, tissue compatibility, age, date of diagnosis and time spent in waiting list. Briefly; as it is not possible to estimate who and when will die and it is not clear which patient will match our blood and tissue group, it is hard to answer definitely when the patients will have a donor kidney. On the other hand, transplant surgery can be planned for living donor transplantations. If no medical, ethical or social contraindication is identified for the patient and donor candidates, kidney transplant can be performed within the shortest time. If all tests are within acceptable ranges following a preparation period of 3 to 4 days in average, patient and donor candidate can be operated on under the most optimal circumstances.
 

Organ donation by living donors:

Donor candidates should be older than 18. Potential donor is informed about the disease of his/her relative for whom he/she wants to donate organ, alternative treatment options for the patient, details of donor surgery and pre- and post-operative risks. At this stage; medical preparations are started for people who insist on organ donation.

Medical tests and examinations are necessary to minimize the possible threats of planned surgery for the donor candidate. It should be determined that organ donation is not subject to a medical, social or ethical obstacle. Being a living donor is an option only for liver and kidney transplants. On the other hand, patient and donor should be related up to 4th degree.

1. Degree: Mother, father, child, spouse
2. Degree: Sibling, grandfather, grandmother
3. Degree: Paternal uncle, maternal aunt, maternal uncle, paternal aunt and niece.
4. Degree: Children of third degree relatives

If the patient is married, relatives of the spouse can also be a donor.

If the kinship relation between the patient and the donor is beyond 4th degree or there is no kinship relation, “Ethics Committee” of Provincial Health Directorates should review the case and make a decision on whether the planned transplant is appropriate or not. The transplant patient should be reviewed by the Ethic Committee of the city, where the hospital is located. For this purpose; the file of patient and donor that consists of a series of documents is submitted to Ethics Committee after medical preparations are completed. Committee members personally meet patients and donors, who are found eligible over the review of medical files. Surgeries can be planned, after Ethics Committee approves the case, but procedures are cancelled for patients and donors who are not approved.
 

Factors that increase popularity of living donor kidney transplantations:

1. The process of waiting for deceased donor kidney is very slow.
2. Outcomes of living donor kidney transplantations are superior to deceased donor kidney transplantations.
3. Transplant kidney starts functioning in a short time and medical care is easier relative to the deceased donor kidney transplantation.
4. Use of minimally invasive laparoscopic techniques for donor nephrectomy has minimized the worries of both donor and recipient about this operation and increased number of donations.
5. Since living donor kidney transplant surgeries are performed in elective conditions, patients can be prepared for surgery under optimal circumstances.
6. Some patients can benefit from “Preemptive Transplantation” before the need for dialysis therapy emerges.

Living donor transplantations enable patients get healthy again and engage in activities of daily life before adverse effects of dialysis on patient’s body develop remarkably. Sometimes, there are voluntary family members who can be considered as donor candidate, but patients believe due to misinformation that they cannot donate organ. If you have any donor candidates, you should present to at least one kidney transplantation center in order to be accurately informed and make a decision accordingly.