Organ Transplantation Center in Turkey, Cost and Treatment Details, Case Samples My Health Turkey has decades of experience and knowledge in the health sector and has been involved and connected with the Turkey’s leading hospitals. In order to guarantee that our patients get reliable and effective medical care we are carefully selecting best doctors and top hospitals to be part of our exclusive network. Through our associate hospitals we are pleased to provide immediate access to kidney transplantation at affordable prices. Patients can rest assured that that we will collaborate and explore all treatment options, providing the best care available. Living liver donor in Turkey In our Organ Transplantation Center; adult and pediatric patients have • Kidney transplant • Liver transplant • Pancreas transplant from living and cadaver donors. In our center, our patients are prepared by specialists in their branches, their operations are carried out safely, and after early follow-up in intensive care units suitable for the age group, they are followed up in the 30-bed isolated organ transplant ward. All living donor kidney donor surgeries are performed with full laparoscopic technique routinely. Our center makes a difference with combined organ transplants (liverkidney, kidney-pancreas transplant) in patients who need more than one organ transplant as well as simultaneous kidney transplant-native nephrectomy, liver transplant-CABG or liver transplantation -sleeve gastrectomy operations. Surgical-oncological treatments of liver-biliary tract and pancreatic tumors related to hepatobiliary surgery as well as living-cadaver donor liver transplants is performed in a multidisciplinary manner with the cooperation of surgery-oncology-gastroenterology and interventional radiology. Procedures such as interventional radiological vascular / non-vascular procedures, endoscopy, endo-sonography and ERCP are performed by the relevant physicians in our hospital in order to solve complications that develop after organ transplant surgeries. Early postoperative follow-up of pediatric transplant patients, for whom all problems are solved by pediatric nephrology, pediatric gastroenterology and other subspecialists, are also carried out in the largest and most comprehensive pediatric intensive care unit of Istanbul within our institution. It serves as an experienced pediatric transplantation center with the number and variety of transplants performed on children, as well as kidney and liver transplants for low-weight babies. we regularly organize training and events to increase organ donation in our country. We draw attention to the fact that thousands of people are waiting for organs at these events. • It means that if a person is diagnosed with BRAIN DEATH, (s)he allows and certifies his/her organs to be used for the treatment of other patients, with his/her free will while (s) he is alive. • Anyone who is over the age of 18 and has a sound mind can donate all or part of their organs according to the law numbered 2238. • Organs can be used after organ donation only when brain death occurs in an intensive care unit. Organs cannot be used in other way of deaths.   Responsibilities of Organ Transplant Coordinator • Accepting organ donations, issuing cards and recording them into the system, • To ensure coordination between the units within the National Coordination System, • Being available 24 hours a day for potential donors and determining donor candidates, • Meeting with the family of the donor candidate, obtaining permission from the donor family if required by the law, ensuring that the organ and tissue donation certificate is approved, • Organizing the removal of organs and tissues in cooperation with relevant surgeons, • To ensure the transfer of the organ and tissue taken to the relevant recipient center, to contact the relevant personnel there and to ensure that the organ, tissue and the recipient are easily brought together, • To accept or reject the tissue or organ by contacting the relevant transplantation physicians in order to evaluate the organs and tissues offered to their center from the National Organ and Tissue Transplant Coordination Center, • Creating and updating waiting lists in the transplantation center and reporting to the National Organ and Tissue Transplant Coordination Center, • Organizing campaigns for organ donation, • (S)he entrusted with and responsible for participating in and supporting all kinds of training and campaigns organized by the Ministry on organ and tissue transplantation in the region. • To provide preparation and transplant coordination of organ transplants with living donors, creating ICS records.  

Laparoscopic Donor Surgery

Living donor kidney transplants have been performed regularly since 1954, increasingly every year, in the world. Laparoscopic donor nephrectomy has become the gold standard in kidney transplant surgeries today, due to the fact that in donor surgery, where a healthy person is operated, it has more aesthetic results and less pain and donors can return to their daily practice with faster recovery. Methods of laparoscopic donor nephrectomy; • Hand-assisted laparoscopic nephrectomy • Unaided laparoscopic nephrectomy • Transabdominal (Full laparoscopic) • Retroperitonoscopic In studies conducted after the definition of the laparoscopic technique, it was found out that the rate of living donors increased by 10% because the donors made the decision more easily for surgery. If there is no anatomical and functional difference in living donor nephrectomies, left donor nephrectomy is generally preferred due to its surgical advantage. In our center, 3 trocars and full laparoscopic technique are used in living donor nephrectomy operations routinely. The rate of living donor nephrectomy in our Organ Transplantation Center is 30%. This rate is 3 times higher than the general practice. Our team performs this procedure in terms of donor safety and health if living donor nephrectomy is required anatomically and functionally, even while using it in laparoscopic technique. Procedures of left laparoscopic donor nephrectomy case with four renal arteries • Renal vessels clearly determined on CT angiography • Careful hilary dissection with full laparoscopic technique • Transection of renal arteries with vascular stapler first • Renal vein transection with a separate vascular stapler • Removal of the kidney through the incision prepared in the groin after dissection is completed • Back table procedure • Urine output after perfusing four renal arteries one by one into the recipient’s left iliac artery.              

PEDIATRIC KIDNEY TRANSPLANT

Total of 80 pediatric kidney transplants, the youngest being 5.5 months old, have been performed in our center in the last two years. Pediatric Kidney Transplant Children who have the chance to have transplant can continue their lives, their education and come together with their families in a healthy way with regular follow-up namely, children can regain their life and future with organ transplant. The rate of pediatric transplant among the total number of transplants is between 10% - 1%, and the factors that cause kidney failure in this age group can be congenital or may occur later. Among the main reasons are ‘vesicoureteral reflux’, which is the backflow of urine to the kidney, stone disease due to metabolic problems, inflammatory diseases of the kidney and infections. Emergency Pediatric Kidney Transplant It comes to the fore when all vascular pathways are occluded over time during the dialysis process of chronic kidney patients and when peritoneal dialysis becomes impossible (peritonitis, intra-abdominal surgery and complications of peritoneal dialysis). The condition of the patient is reported and submitted to the National Coordination Center. If approved, it will be offered to the national cadaver donation system. Emergency kidney transplant is performed when medical facilities allow.      

CROSSOVER KIDNEY TRANSPLANTATION

In our center, a total of 40 patients have had cross-over transplantation, in which 12 patients in triple and 28 patients in double cross-over transplant. Cross-Over Transplant • Cross-over organ transplantation is the procedure performed when organ transplant recipients who do not have the chance to get organs from their relatives for medical reasons have the chance to mutually share the organs of two or more couples who are compatible and have a healthy transplant. • Cross-over transplantation is mostly used in kidney transplantation today. It is usually performed in cases where transplantation from their own donors is not appropriate due to incompatibility of blood group or antibodies formed in the recipient’s blood. • Matching of cross-over organ transplantation are performed by transplantation centers in our country. • This method is the most appropriate way to increase the number of living donor transplants in ethical, medical and legal terms accepted all over the world. • This double, triple and more matched cross-over transplantation method is the hope of many patients who have no chance of transplantation.     DESENSITIZATION IN PATIENTS WITH IMMUNOLOGICAL RISKS 17 patients who were transplanted after desensitization due to immunological risks and 6 patients whom we had to perform cross-over transplant due to immunological risk have got over dialysis treatment due to chronic renal failure. Immunological risk varies in kidney transplant candidates due to previous multiple pregnancies, blood transfusions, retransplantations, previous bacterial and viral infections, and primary diseases such as SLE and vasculitis. • The risk of rejection is high in kidney transplantation in highly sensitized patients. In order for these patients to be transplanted, the degree of sensitization of the patient should be determined before transplantation and the patient should be desensitized. In the immunology laboratory within our center, we determine risks performing all tests for our patients. • We apply our own desensitization protocol to remove donor-specific antibodies (DSA) from the circulation, reduce their amount, and control the activity of B lymphocytes and plasma cells responsible for DSA production for desensitization. Despite this, we can apply transplant to our patients, who we consider at risk, by matching them with other ideal couples in our list with cross transplantation within the donor exchange program.

NATIVE NEPHRECTOMY

In adult and pediatric patients whose indication is determined during heterotopic kidney transplant surgeries, removal of native kidneys is usually performed simultaneously. Native Nephrectomy Indications: • Chronic Pyelonephritis and Infections • Nephrolithiasis • VUR • Severe proteinuria • PCKD • Suspected tumor

NEPHROLOGY AND HEMODIALYSIS UNIT

Hemodialysis service is provided to patients with chronic kidney disease undergoing dialysis in preparation for kidney transplantation, or to patients who require emergency dialysis admitted in other clinics of the hospital. • Individualized treatment options are determined and applied for the patients with the latest technology hemodialysis machines, nephrology physicians and expert staff. • Hemodiafiltration, which means performing the hemodialysis process together with ultrafiltration, is applied 24/7 at the bedside, especially in patients with severe chronic renal failure without urine output and in patients with renal failure in intensive care. • With the awareness that kidney transplant is the best treatment in terms of patient life time and quality of life in chronic kidney disease, we stand by the patients from the pre-operation period till the last hemodialysis sessions in terms of equipment, personnel and quality.  

A-V FISTULA SURGERY

A-V fistula surgeries, which are performed for patients who are on dialysis due to chronic kidney disease, to enter dialysis easily, are carried out by experienced vascular surgery specialists in our clinic. The vascular surgeon may request the following examinations if (s)he deems necessary after the examination; Ultrasonography; The veins in the area planned to be used for vascular access can be evaluated in terms of suitability of diameter, stenosis, occlusion and blood flow. The vessels can be mapped before the surgical procedure. Venography; The veins that cannot be assessed adequately by ultrasound or need to be examined in more detail are evaluated. It may be particularly useful in patients who have had A-V fistula several times but sufficient flow cannot be provided. Computed Tomography or Magnetic Resonance Imaging is rarely used for venous anatomy in the arm. The purpose of these imaging methods is to find the appropriate vein for intervention, to select the appropriate method for the patient for the planned technique, and to provide a long-lasting vascular access with sufficient flow to achieve effective hemodialysis. These procedures are generally performed with local anesthesia as a daily surgical procedure. In some cases where the vascular surgeon deems necessary, different anesthesia methods can be used. Depending on complexity of the procedure, patient’s hospitalization is determined. Hemodialysis is allowed after the check-up performed by the vascular surgeon 2-3 weeks after the surgery whether the performed A-V fistula is functional or not.

CATHETER AND FISTULA PROCEDURES WITH INTERVENTIONAL RADIOLOGY

Hemodialysis procedures are performed with the help of a fistula inserted between a suitable artery and a vein in the arm. Hemodialysis is performed with the help of catheters that are temporarily inserted through areas such as the neck, chest and groin until completion of the healing process, in which the fistula is waited to become usable in patients with a fistula put into the arm. • Dialysis is performed using a permanent tunnel catheter in patients with any obstacle to opening a fistula by surgical operation. In both cases, catheter procedures are performed by interventional radiology. Necessary precautions should be taken against the risk of infection after the procedure and during the process of using the catheter, and the condition of the catheter should be checked regularly. • In case of obstructed or insufficiently functioning fistulas, interventional procedures are performed in angiography. These procedures are treatments such as thrombolysis (clot dissolution), thrombectomy (clot removal), balloon angioplasty (widening of vessels), endovascular stent insertion (insertion of a stent into the vein). These procedures are performed in the angiography unit by the interventional radiologist. • In cases of central venous stenosis or occlusions that affect fistula performance, the vein is opened interventionally by balloon angioplasty and/or stent applications. Fistula venous pressure decreases, edema in the arm or upper chest decreases, swelling lowers. • Thanks to new technology, intravenous fistula opening procedures without surgery have recently been benefitted as a new method in suitable patients. The advantage of this method is that the patient can go home without encountering an infection or waiting for wound healing. In addition, thanks to the rapid fistula maturation, the patient starts using the fistula early.  

LIVER TRANSPLANT

Liver Transplant Indications - Cirrhosis - Acute liver failure • Cadaveric Liver Transplant: It is the procedure of transplanting the liver, which is brain dead for various reasons and donated upon family consent. The patient to whom the cadaver liver will be transplanted is determined from the cadaver waiting list according to the medical emergency. • Living Donor Liver Transplant: It is the procedure in which a piece of liver is transplanted being taken from volunteers who are older than 18 years old and younger than 55 years among the relatives of the patient with mental balance up to the 4th degree. A medical examination of the volunteer relative donors is made and it is decided whether they can be donors or not, and the transfer is planned according to the result. Apart from this, if there is no suitable donor among the relatives of the patient, it may be discussed that non-relatives to be donors. However, this requires an evaluation by the Provincial Ethics Committee. Its conditions are determined by law and announced in the Official Journal on March 5, 2010. Right lobe, left lobe, left lateral segment to be taken from living donors or monosegment graft hepatectomies performed in our center in line with the decisions taken by the liver transplant council after routine intraoperative ultrasonography and peroperative cholangiography after laparotomy, is carried out simultaneously with the recipient surgeries. Our team performs both cadaveric liver transplant and living donor liver transplant. A total of 187 liver transplants have been performed for adults and children so far in our center. Please click for more about liver transplant

LIVER TRANSPLANT INDICATIONS

Any patient with liver cirrhosis should be evaluated for transplant in accordance with international guidelines. In addition to the severity of the liver disease, the clinical condition of the patient and the development of complications affect the transplant decision. • Cirrhosis • Liver tumors that have not spread beyond the liver • Acute liver failure • Some parasitic diseases such as alveolar hydatid cyst • Some congenital metabolic and hematological diseases • Transplantation can be performed in major liver injuries after trauma.

A timely transplant surgery with a suitable donor liver results in approximately 80-90% success rate.

CROSSOVER LIVER TRANSPLANT

Cross transplant, in which organ transplant recipients who do not have the chance to obtain an organ from their relatives due to medical, surgical and technical reasons have a chance to mutually share organs with the donor of another eligible couple and have a healthy transplant is also applied in liver transplant and is a method that is used when problems related to liver capacity of the donor or vascular/biliary tract anatomy pose an obstacle except for blood group incompatibility, and it is a method that allows two people to transplant at the same time. This method is applied in our center successfully.

PEDIATRIC LIVER TRANSPLANT

Liver transplantation is the most effective treatment method for liver failure that has started in infancy or later and becomes chronic, or acute fulminant liver failure developed in a healthy child. Indications: • Biliary atresia • Congenital hepatic fibrosis • Wilson’s disease, alpha-1 antitrypsin deficiency, tyrosinemia, etc. genetic diseases Metabolic Diseases, Familial Hypercholesterolomy, Criggler-Najjar Syndrome • Cholestatic liver diseases, particularly PFIC-2 • Hepatoblastoma • Acute fulminant liver failure     PRE- AND POST-TRANSPLANT INTERVENTIONAL RADIOLOGICAL PROCEDURES Vascular and non-vascular interventional radiological procedures are performed in a high-level solution-oriented manner, thanks to development of medical technology and experienced interventional radiology expertise before and after transplant. Procedures Performed: • TACE, TARE, Microwave and RF ablation procedures in liver tumors in transplant candidates • Diagnostic liver and kidney biopsies • Pleural and peritoneal collection drainage • Nephrostomy and antegrade stenting • Dilatation procedures for ureteral stenosis with balloon • Lymphocele and urinoma drainage • Vascular interventions in liver and kidney transplants • Intraoperative hybrid interventional procedures in portal vein stenosis or occlusion • Antegrade dilatation and stenting procedures in bile duct stenosis and leakages • TIPS (Transjugular intrahepatic portosystemic shunt) procedures    

AFTER TRANSPLANT

Organ Transplant Polyclinics: There are coordination, nephrology, gastroenterology and surgical examination rooms and council room within the organ transplant department isolated from other departments on 2nd floors of the hospital. Preoperative preparations and post-operative follow-up of the patients are performed here. Kidney Transplant Handbook: After surgery, patients with kidney transplants are prepared for their new lives at home, accompanied by a manual of medication and lifestyle training. Liver Transplant Handbook: After surgery, patients with liver transplants are prepared for their new lives at home, accompanied by a manual of medication and lifestyle training. Transportation: Our organ transplant service vehicle is used to provide transportation of patients coming from outside the city from the bus terminal or airport, and from places such as hospital hemodialysis center.

HEPATOBILIARY SURGERY

Hepatopancreatobiliary surgery (HPB) is a special field that includes the surgical treatment of patients with liver, pancreas, gall bladder and bile duct diseases. However, some benign diseases such as liver cysts, bile duct injuries and chronic pancreatitis may require surgical treatment. • Malignant tumors of the liver • Benign tumors of the liver • Hydatid cyst of the liver • Portal hypertension shunt surgeries • Gall bladder surgeries (laparoscopic) • Bile duct tumors • Pancreatic cancers • Pancreatic cyst surgeries • Kidney tumors infiltrating VCI   Our center makes a difference not only in the field of organ transplant, but also in the field of organ donation in our country and in our region with the works of its experienced organ transplant coordinators and its awards in this field. It ensures that patients who have a living donor in both kidney and liver transplants but cannot undergo surgery because they are not appropriate for transplant, achieve this miracle treatment by matching them from their own crossover transplant pool.