Description

Kidney Transplant Center

Introduction

End-stage kidney failure is characterized by complete loss of
kidney functions and requirement of dialysis and kidney transplant to survive.
Kidney transplant is a surgical procedure that transfers one kidney of a donor
to the patient. A kidney of a living or deceased donor can be used for
transplant.

Diagnosis and Treatment Services Available in Kidney
Transplant Center

Acıbadem Kidney Transplant Centers offer diagnosis and treatment
services for both adults and children based on a multidisciplinary approach in
fields of radiology and anesthesiology.

Laparoscopic technique, also called closed method, is usually
preferred for donor nephrectomy that implies surgical removal of donor kidney.
Kidney is removed with transvaginal approach in selected female donors.
Undergoing kidney transplant surgery in Acıbadem Kidney Transplant Centers, the
patients are postoperatively followed up at regular intervals by relevant teams
of the center.

What is end-stage kidney failure?

End-stage kidney failure implies “irreversible impairment of
renal functions”. End-stage kidney failure is characterized by complete loss of
kidney functions and requirement of dialysis and kidney transplant to survive.

Each patient with documented end-stage kidney failure should be
evaluated regarding kidney transplant! Kidney transplant is a surgical
procedure that transfers one kidney of a donor to the patient. There are two
sources of donor kidney: A living donor or a deceased donor (a person with
verified brain death).

Which relatives can be a donor?

“National Organ and Tissue Transplant Coordination System” is
put into force by Ministry of Health in order to facilitate supervision and
audit of living donor organ and tissue transplantation. Accordingly, living
donor organ and tissue transplantation is approved for up to fourth degree
(included) blood and in-law relatives.

Organ and tissue donor candidates who fulfill this criterion are
discussed in Local Ethics Committee of relevant Organ and Tissue Transplant
Center and a transplant surgery is performed only after it is verified that
certain criteria are met.

Regarding fourth degree relation, Article 17 of Turkish Civil
Code states as follows: degree of blood relation is determined through number
of deliveries, which relates kin to each other.

According to Degree of Blood Relation;

First degree relative: Mother, father, kid

Second degree relative: Sibling, grandfather, grandmother and
grandson.

Third degree relative: Paternal uncle, paternal aunt, maternal uncle,
maternal aunt, nephew (kid of sibling).

Fourth degree relative: Children of third degree relatives.

For in-law relation, relatives of the spouse are identically
determined.

Unrelated Donors

Living donor organ transplant can use organs donated by spouse,
who is actually married for two years, and up to fourth degree blood and in-law
relatives.

On the other hand, persons with no blood or in-law relation can
donate organs. However, relevant laws mandate a very careful investigation.

For living donor transplants excluding above mentioned living
donors, the Ethics Committee of the city, where the transplant surgery will be
performed, should verify that there is no illegal link between the donor and
the recipient and organ donation is appropriate from perspective of ethics.

In this case, the recipient and the donor should be referred by
Provincial Health Directorate to the committee.

Who cannot be a living donor for kidney
transplant?

• Below 18 years of age
• People with hypertension (>140/90 mmHg) or who uses antihypertensive agent.
• Diabetics
• Proteinuria (250 mg/24 hours),
• History of recurrent kidney stone,
• Low GFR (<80 ml/min)
• Microscopic hematuria
• Urologic anomalies in kidney
• People with a severe medical condition (chronic lung disease, recently diagnosed cancer)
• Obesity (people with body weight >305 of optimal body weight)
• History of thrombosis or thromboembolism
• Individuals with psychiatric disease
• Family history strongly notable for diabetes mellitus, hypertension and kidney disease.

Why is living donor preferred for kidney transplant?

Living donor is a preferable condition for kidney transplant. It
has many advantageous for the patient over kidneys removed from people with
verified brain death.

• Better short-term outcomes (Survival rate of graft: 95% vs. 90%)
• Better long-term outcomes (Survival of graft: 12 to 20 years vs. 8 to 9 years)
• Earlier onset of renal functions and easier manipulation of patient
• Lack of stress arising out of brain death
• Lower probability of late-onset functioning of graft
• Bridging to transplant for the transplant team and the patient
• Relatively milder immunosuppression
• Psychological support, as the pressure of supplying a kidney from a donor with brain
  death is eliminated

How is a kidney selected that is most appropriate for the
transplant?

Kidney transplant surgery requires ABO compatibility between the
donor and the recipient, as is the case with blood transfusion. 0 is the blood
type of general donor and AB implies the blood type of general recipient.
According to this rule;

Rh system is not a factor for kidney transplant. A person with
Rh negative blood can donate one kidney to a patient with Rh positive blood.
Tissue typing is also required for the recipient and the donor. However, it
should be known that tissue match is not a must for kidney transplant.

What is crossover transplantation?

This method is reserved for patients with no blood
type-compatible donor among relatives. If a related donor volunteers to donate
kidney despite ABO incompatibility, the pair of this incompatible donor and
recipient is matched with another incompatible pair in organ transplant
centers, provided tissue match is taken into consideration.

For example, a related donor with Blood Type B of a recipient
with Blood Type A donates kidney to another patient with Blood Type B, while
the donor with blood Type A of the second patient donates kidney to the first
patient.

Patients with blood type A or B can be candidate of crossover
transplantation, if there is no donor with compatible blood type. Here, one
should know that chance of crossover transplant is lower for patients with
Blood Type 0 or AB.

May a donor organ removed while patient is in
coma or vegetative state?

Brain death of a person should be necessarily verified in order
to remove a donor organ. People with confirmed brain death have no chance to
survive. On the other hand, a person in coma or vegetative state may survive,
as the function of brain is not irreversibly lost. Therefore, a donor organ
cannot be removed while a person is in coma.

How is an organ of a person with confirmed
brain death transferred?

Removal of kidney from a person with confirmed brain death, but
with a beating heart: This group of patients mostly consists of people with
cranial trauma secondary to traffic accident or a cerebral hemorrhage secondary
to various causes. Organs of these patients form the most important source of
transplants from a donor with confirmed brain death.

Removal of kidney from a person with confirmed brain death and
non-beating heart: Heart of these patients stops beating after brain death is
confirmed. Organ supply from these patients is more difficult than patients
with beating heart and verified brain death. It is not commonly performed in
our country.

What happens after organs of a patient with
brain death are donated?

Relevant laws of our country impose that for a deceased donor
kidney transplant, the donor should have donated organs while s/he was alive or
consent is obtained from relatives after brain death of the donor is confirmed.

After consent is obtained, the donor is transferred to intensive
care unit and blood compatibility and tissue match are examined. Organs are
transferred to recipients who are selected over the waiting list, where
relevant characteristics and tissue types of patients are recorded. If a
removed organ will be transferred to a patient in another transplant center,
appropriate storage conditions are ensured for the organ and it is transported
to the center with the fastest transportation means available.