Every year, many people around the world fall victim to kidney failure. And the number of donors does not match the growing need for kidney transplants. The state of affairs in organ transplants and donations in Turkey is significantly better than it was a decade ago. There are also promising developments in the field of cadaveric organ transplantation. The number of notified brain deaths is also growing steadily.

So what do we know about organ transplantation and donation? Organ transplantation and awareness around the issue in Turkey have grown in leaps and strides in recent years.Public awareness ads and the work of the Ministry of Health have played a significant role in the growth in the number of donations.

The aim of Yeditepe University Hospital, says the Head of the Nephrology Department Prof. Dr. Gülçin Kantarcı, is to provide effective support for people who are fighting for their lives as a result of the lack of donated organs, and to increase their quality of life. Professor Kantarcı explains that Yeditepe University Hospital organizes training sessions and organ donation campaigns designed to increase organ donations and raise awareness.

We sat down with Professor Kantarcı, who answered our questions about organ donations and kidney transplantation.

When is a kidney transplantation needed?

Basically, in cases we diagnose as chronic renal failure. Transplantation becomes necessary in cases when the patient’s kidneys reach advanced stages of disease that render the kidneys unable to fulfill their essential function to clear the blood of waste products after the body has used what it needs from what we consume in terms of nutrition and medicine by producing urine to expel them. Patients with advanced chronic renal failure who have not been matched to a suitable donor organ receive hemodialysis or peritoneal dialysis. About 60,000 patients continue to receive hemodialysis in Turkey. Yet the most effective and optimal treatment for later stage chronic renal failure patients in need of renal support treatment is kidney transplantation.

What are the sources from which organs may be obtained for patients requiring kidney transplantation?

There are two possible sources for organs – living donors, or cadavers from people who have suffered brain death.

Who might the living donors be?

They might be anyone from a patient’s first degree (parent or child) relation to a fourth degree relation (cousins and siblings’ grandchildren). Likewise, the patient’s spouse and relatives up to the fourth degree may also be living donors. In addition, non-relative donors with close emotional ties to the patient and who are specifically approved by the relevant health authorities may donate a kidney to the patient. Children under the age of 18 are not permitted to become donors. Clearly, the donor must be willing and agree under his or her own free will.

What is brain death? Is it possible for a person who has suffered brain death to return to life?

Brain death is when a person suffers irreversible loss of brain and brain stem function. In these cases, the patient eventually loses all other organ and vital functions in spite of all medical intensive care unit support. It is not possible for patients diagnosed as brain dead to return to life or to be resuscitated.
The concept of brain death is not always well understood: it constitutes medical death, which is an irreversible state.

What are the popular hesitations about organ donation?

The most widespread concern is about the loss of bodily integrity or wholeness, although there is actually no question of such a loss occurring.

There is sometimes also a concern about who the recipient will be. We can address this concern very clearly. The Ministry of Health’s NATIONAL COORDINATION SYSTEM’s waiting list of patients requiring urgent transplantation is screened for the most suitable recipient based on urgency, with a view to tissue and blood group compatibility regardless of the patient’s status, wealth, religion, language, ethnic origin or gender.

Could you tell us a bit about the quality of life of patients after kidney transplantation?

The normal post-op hospitalization period is between one and three weeks. Patients begin a new life with a new kidney. After the transplant, kidney patients can enjoy a normal family and home life, getting back to their previous social and working lives. That said, it takes some time for the body to regain full strength after the transplant.

In the first 6 months particular care needs to be taken with respect to protecting the organ and guarding against opportunist infection.

After the kidney transplant, the patient’s appetite grows as the new kidney rapidly clears the blood of harmful substances. In addition, getting back to a new and normal life also has a positive impact on appetite. It should also be remembered that cortisone medication also serves to increase appetite.

This means that in most cases, patients eat a lot and put on weight after their kidney transplant. Weight gain affects the metabolism and the amount of waste products expelled by the kidney. This puts an extra burden on the kidney and increases the possibility of kidney damage. In addition, excessive eating can cause an increase in blood sugar levels.

Successful kidney transplantation, whether cadaveric or from a living donor, restores the entire kidney function, not just a part of the function like kidney dialysis treatment. Moreover, the patient’s quality of life is much better since total kidney function is restored and the patient is freed from the physical and psychological difficulties of continuous dialysis procedures.

Do patients have to undergo lifelong medication after transplantation?

The immune systems of living beings work to eradicate or neutralize various foreign substances (antigens) that cause an immune system to produce antibodies against them. In other words, the cells that are the body’s building blocks possess antigens recognized by the immune system. The immune system recognizes these antigens and does not then combat the body’s own cells. But a cell entering the body from outside, which harbors different antigens, causes the immune system to swing into action against the foreign antigens. Just as the immune system combats a microbe it perceives as foreign, it might also perceive the transplanted organ as a foreign body and act against it. Immuno-suppressive medications are used in order to minimize this activation. Since the body will never ‘forget’ a foreign organ, these medications need to be used for as long as the organ lives. As well as immuno-suppressives, antibiotics and antiviral medications need to be used for a temporary period after the transplantation. In some cases, medication to reduce blood pressure and cholesterol may also be prescribed. The use of these medications is quite intensive in the first 6 months after the transplantation. After this period, the number and dosage of medications may be reduced, according to the patient’s clinical progress. Regular use of immuno-suppressive medication is particularly important for the health of the kidney.

What is the procedure for getting a kidney transplantation?

Advanced renal failure patients who wish to receive a kidney transplant need to apply to an Organ Transplantation Center. Candidates assessed in nephrology clinics are referred to organ transplantation coordinators and surgeons. In the case of living donors, donor and recipient candidates are subject to a thorough evaluation after which as long as there is no impediment to the kidney transplantation taking place, the procedure is performed as soon as possible. İn cadaveric cases, applicants are placed on the national cadaver waiting list by the concerned organ transplantation center following all necessary examinations including blood and tissue group analyses.

What is Yeditepe University Hospital doing in the field of organ transplantation?

As a kidney transplantation center, Yeditepe University Hospital performs kidney transplantations carried out by our dedicated team of proven, experienced specialists. Our aim is to hold out a helping hand to kidney failure patients awaiting organs in an environment in which they are assured the highest standards of health, safety and quality.

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