Liver donation and liver transplantation in Turkey. In this article, we will present the most important conditions and contraindications for donor liver transplantation in Turkey.
Beginning in liver transplantation:
Who are the people who can donate liver?
Initially, the donation process is done by transferring part of the donor's liver to the patient, after removing the patient's liver and transplanting the part taken from the donor.
Many donors are concerned about the idea of taking part of the liver and the possibility of it affecting their health in the future, but the liver grows again until it returns to its previous size after three months, and the transplanted liver grows in the patient to reach the size of the normal liver in the same period as well. About three months after the operation.
The donor undergoes comprehensive examinations before the operation to prevent him from being exposed to any danger that the liver transplant may pose to his health.
Conditions to be met by the donor
- To donate of his own volition. And that the donor is over eighteen years old.
- That the donor's blood type matches the recipient's and that there is a tissue match between the donor and the recipient.
- His liver is anatomically and functionally healthy
- The donor must be a relative of the patient up to the fourth degree.
- Relatives of the wife are considered relatives to the same degree as the wife.
- In the event that he is outside this kinship, a meeting takes place between the donor and the city’s mufti and the highest authority in the region to make sure that the donor wants to donate according to his complete will and without any financial compensation. (This condition is specific to Turkey).
Factors that prevent liver donation
- If the donor has hepatitis B or C or acquired immunodeficiency virus (AIDS).
- Or the donor has drug or alcohol addiction.
- That the donor has cancer.
- The presence of untreated mental illness in the donor.
- Having some vascular diseases that technically prevent the operation.
- Presence of high blood pressure and diabetes diseases that prevent the donor from undergoing the operation.
A team of doctors determines the availability of conditions for both the donor and the recipient, and accordingly, the decision to perform the operation is taken.
In general, what blood types can correspond to a liver transplant?
There are several cases of compatibility between the blood types of the donor and the recipient:
- A donor whose blood type is (O) can donate to all blood groups.
- A donor with blood type (A) can donate both blood types (A) and (AB).
- A donor whose blood type is B can donate to both B and AB blood types.
- A donor with blood type (AB) can donate only those who have blood type (AB).
Important note: There is no effect if one group is positive and the other negative.
What after donating part of the liver?
After the grant process, the donor must stay in the hospital for 7 to 10 days, and he must rest for three to four weeks before resuming his previous physical activities before the operation.
After this period, the patient can return to his normal life, but without doing hard work and exercises, which he can return to after 6 weeks of the operation.
The donor resumes his sexual life when he feels that he can, as for strenuous sports it is recommended to return to it 3 months after the operation
Tests that the donor must undergo before a liver transplant
- All blood and urine tests.
- All blood tumor analyzes.
- Liver tests.
- Viral hepatitis tests.
- Screening for infectious diseases such as AIDS.
- Chest radiograph.
- Cardiac radiography, plus ECG if necessary.
- Echo belly.
- Computed tomography of the liver.
- Magnetic resonance angiography of the bile ducts.
Pros of liver transplant from a living donor
The main advantage is the possibility of performing the operation in a timely manner for the patient, without putting the patient on a waiting list as in the case of transferring from a deceased donor, and the percentage of deceased organ donation in Islamic countries is low, which exacerbates the suffering of patients and prolongs their waiting time.
In addition, obtaining a liver from a dead donor for foreigners in Turkey is not available.
Volume taken from donor liver
In general, about 40 to 70% is taken from the donor's liver, as the liver is divided into right and left lobes. The presence of this anatomical division allows them to work independently of each other, as the right lobe occupies about 60% and the left about 40%.
It is worth noting that the gallbladder is also removed for the donor so that it is not affected after the operation.
The number of donated liver lobes
Although each person has only one liver and cannot live without it, it is possible to donate a portion of the liver to be transplanted to another person.
Lobar anatomy (see figure below) allows surgeons to create grafts of various sizes, depending on the recipient's requirements for liver tissue.
The partial liver will grow in both the donor and the recipient to provide normal liver function for both people.
Historically, this procedure was developed so that it can Liver transplant procedure For children as it was difficult to find suitable livers from deceased donors for this group of patients.
For pediatric liver transplantation, a single section consisting of segments 2 and 3, known together as the left lateral segment representing 20-25% of the entire liver volume, is usually used.
However, a liver transplant to an older child or young adult may require segments 2, 3, and 4, together known as the left lobe and representing approximately 40% of total liver volume.
However, over the past decade, this technique has been further expanded to include transplantation in adults using right lobe segments 5, 6, 7 and 8, which represents approximately 60% of the total liver volume.
Living donor liver transplantation (adult donor to adult patient) is a very complex, technically challenging and risky process for both the donor and the recipient.
When is the liver transferred to the patient after donating it?
Donation and transfer operations are performed at the same time, where the liver is transferred to the patient without waiting.
Can anyone be a liver donor?
The donor must be between 18 and 60 years old.
It is preferable that the donor and the patient have the same size (to ensure that the parts of the liver are the same size for both), and the donor must be aware of the risks that he may be exposed to by performing the operation, and he must adhere to the doctors’ instructions in the long and near term after the operation.
Should there be a relationship between the donor and the patient?
The donor can be a relative up to the fourth degree, and in the absence of kinship, this is done by a decision of the donors and decided by the Ethics Committee of the Ministry of Health in the country in which the operation is performed.
Does the presence of kinship reduce the risk of the patient's body not accepting the transplanted liver?
This does not affect the body’s ability to accept the transplanted part, as the body is subject to complete immunosuppression, and if the doctors acknowledge that there is a match before the operation, the increase in the proportion of kinship is not considered a factor in the body’s rejection or acceptance of the transplanted organ, as it is possible that rejection will occur even if the donor is Sick twin.
How is the donor evaluation process for liver transplant in Turkey in detail. What are the conditions for liver transplantation?
Evaluation process for a living donor:
The blood type of the donor and the patient must match according to what we mentioned above, and the donor's liver must be normal and of an appropriate size.
In addition, care must be taken to ensure that the donor does not have any psychological disorders that would complicate this procedure. Also, one of the important conditions is that the donor does not have an infectious disease that can be transmitted to the patient after the transplant, and that the donor is of his own free will when undergoing the operation.
Can my private doctor do the evaluation?
Since organ transplantation is a detailed process, it is best to have all the tests and evaluation done by a complete and specialized team who can make a comprehensive assessment of all points associated with the transplant.
That is, all the tests will be returned to the hospital where the operation will be performed, in order to ensure the tests and in the interest of the lives of both the donor and the recipient.
The first step It is the determination of the blood group, where both the donor and the patient must be compatible, regardless of whether they are positive or negative for the rhesus factor.
The second step It is a detailed examination of the abdomen and liver area through computed tomography and ultrasound imaging (Echo), where the tomography gives detailed information about the liver and measures the volume and blood flow to and from the liver.
Should previous examinations be performed without eating?
Magnetic resonance examination of the pancreas requires a fasting period of 3 to 4 hours. In the case of a CT scan, the patient must stop eating 8 hours before, the patient can drink water before that, except in specific cases recommended by the specialist doctor.
The presence of escorts next to the donor, the presence of a person accompanying the donor enables him to ask all the questions that may come to his mind and helps him to inquire about any part related to the operation.
The presence of a companion to help the patient after the operation helps in accelerating the recovery of the patient and supporting him morally.
When can a donor know if he or she can donate a liver?
The donor is informed immediately after the evaluation of the medical committee is completed. However, some advanced medical tests may be recommended, which are believed to affect the surgery. It is important for the donor to understand the information given to him, especially since the decision to donate the liver is a serious decision.
Who is the final decision-maker in the possibility of carrying out the transfer process from the donor to the patient?
After completing all the necessary tests, the specialized medical committee reviews the results of the tests. This committee includes doctors, surgeons, nurses, radiologists, anesthesiologists, psychiatrists, in addition to the doctors who evaluated the condition of the donor during the examinations, and the decision is taken after obtaining the approval of the entire medical committee.
After obtaining the approval of the committee, when is the liver transplant performed?
The decision is made depending on the patient's condition, and accordingly, the preparation for the operation begins from coordinating the operating room to the presence of surgeons, nurses, anesthesiologists and other equipment required for the operation.
Does the patient's infection with a liver disease affect the decision to transfer the liver or not?
The process of transferring part of a healthy person to another patient is a great sacrifice for the donor, except in the case of some diseases such as liver cancer, which may cause the patient to relapse again after the operation.
This will be discussed in detail with the patient, where possible medical complications are presented in addition to all the details and possible possibilities.
The duration of the operation for the donor
It takes between 4 and 6 hours.
As for the recipient, it takes between 6 and 8 hours.
Potential risks of liver donation
The risk to life when donating a liver does not exceed 0.2%, which is very low. Other risks such as postoperative bleeding or bile leakage that require blood transfusion and postponement of the operation are all considered so low that they are possibilities that must be taken into account.
But as we mentioned, in the event of one death of the donor, the transplant department is closed permanently.
Usually the medical team explains all the risks and complications that may occur, and perhaps the most important complications are bile leakage, wound infection and some intestinal disorders (constipation, indigestion, nausea) and they can resolve within weeks.
What about the removal of the cholestasis of the donor during the liver donation process?
Yes, cholestasis is removed, but as it is known, cholecystectomy does not have any negative impact on the life of the donor after the operation.
Is blood transfusion needed for the donor during the liver donation process?
This is very rare, but it may be needed in some cases.
And does the donor have to stop drinking alcohol before the liver donation procedure?
It is best not to drink alcohol, and the donor should inform the doctor in case of previous alcoholism.
Alcohol abuse is not an obstacle to liver donation, but the donor must perform a liver biopsy to check for alcohol damage to the liver.
Should I stop taking medicines before making a liver donation?
This decision is up to the specialist doctor.
However, aspirin and similar medications should be discontinued 7 days before surgery or examination.
Because such drugs prevent clotting, which increases the incidence of bleeding significantly.
Women who are taking contraceptives or hormone replacement therapy are also advised to stop taking them as well.
As these drugs increase the risk of complications in the postoperative period because they increase the speed of blood clotting significantly.
How long does the liver donation process take for the donor to return to work?
The minimum rest is 4 to 6 weeks since the recovery period varies from person to person, and it may take 8 to 12 weeks for the pain and fatigue to completely disappear.
After liver donation:
Will the surgery leave any scar? How long is the wound?
In general, the incision will shrink quickly and gradually over time, but eventually there will be a permanent visible scar. Where the incision takes the shape of the letter Y or J.
Does the donor suffer from a lot of pain after the operation?
It is normal for pain to appear after the anesthesia wears off in the first three days of surgery, but the pain is estimated and an attempt is made to relieve it through medications.
Will I live a normal life after liver surgery?
In the absence of any complications, you can return to your normal life in about three months, and there is very little risk of long-term complications.
Return to sexual life after liver donation
In a few weeks, this is mainly due to how well you have regained your strength and health.
If the donor is female, when can she become pregnant after the operation?
It is not possible to set a specific date, but it is recommended not to get pregnant for at least six months after the operation.
When can contraception and hormone replacement therapy be resumed after the operation?
Doctors recommend returning to it at least three months after the operation.
When does the liver reach its normal size after the liver donation process?
The liver begins to regain its size immediately. It is very active in the first two weeks but reaches its old size at the end of the three months after the operation.
If I donate the liver, can I donate the liver again?
No, once a certain part of the liver is donated, it cannot be donated again.
When can the donor start exercising?
Once the donor has recovered from anesthesia, he or she can exercise.
He will be asked to do breathing and coughing exercises, and he will also be asked to do physical relaxation exercises and muscle relaxation in the legs.
He can also start walking a day or two after the operation with the help of a crutch.
Walking is of great importance in accelerating the healing process and reducing postoperative complications (such as blood clots, pneumonia, and muscle wasting), as the donor will be asked to walk for specific periods after the operation according to the doctor's instructions.
He will be able to return to his previous life within two to three months.
How long will I be able to drive after the liver donation procedure?
It is recommended not to drive for 4 weeks after the surgery, before you decide to drive, you should be physically and mentally healthy, your reflexes in place, and most importantly, you should not have problems in the abdominal area.
How long can the donor do some strenuous activities such as jogging, swimming and lifting weights after the liver donation procedure?
During the first six weeks, be careful not to lift weights in particular until the abdominal wall heals, and the weight lifted should not exceed 5 kg.
If he does not have any complications and feels well after 6 to 8 weeks, he can return to his usual daily activities, which include sports including swimming, jogging, exercise and cycling.
However, he must be very careful with abdominal exercises, as you should start lightly and gradually increase the exercise^,
When can the donor travel or fly?
You should not plan to travel for 4 weeks, preferably up to 12 weeks, and if the operation is performed in a place other than your place of residence, it is recommended to conduct postoperative reviews in your place of residence.
How long does the donor have to stay in the hospital?
On average, the duration is about 7 to 10 days
Finally, what is the expected cost of a liver transplant?
The cost varies according to the center, whether it is governmental or private, in addition to the international arrangement of the hospital.
The presence of other factors such as the patient's infection with viral diseases such as hepatitis B may affect the price.
But in general it can be said that it starts from 50 thousand US dollars. We provide you with the best and cheapest liver transplant center to suit your financial condition.
It should be noted that patients who donate liver can deteriorate their psychological condition, but they quickly return to normal within six months.
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You can visit some liver transplant centers to learn about liver transplantation in Turkey in detail for the donor and the recipient by visiting the hospitals and other articles.
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The most important frequently asked questions about liver transplantation in Turkey in detail for the donor
Liver transplantation in Turkey is only done by a deceased person or a donor from the patient's relatives from the first degree to the fourth degree. As for taking from a deceased person, this is not available if the person is a foreigner. Therefore, the liver can only be obtained if there is a donor from the patient's relatives.
In general, it varies according to the center and the presence of a viral infection such as hepatitis B, but the cost of liver transplantation in Turkey starts from 50 thousand US dollars.
Although the success rate of the operation in Turkey is higher, the cost of liver transplantation in Germany exceeds 100,000 US dollars.
It is impossible to donate more than once, even if the liver has returned to its normal size.
The best hospitals for liver transplantation in Turkey are Koç Hospital, Turgut Ozal, and Medical Research Hospital in Ankara, in addition to several other hospitals.
The cost in India also starts at $31,000, which is very close to the prices in Turkey. However, it suffers from the problem of a higher possibility of viral infection after immunosuppression than in similar centers in Turkey and other countries.
According to the studies, there is no effect on the patient's age, and there are no disabilities due to donation.
This is not possible because the liver cells are the ones that control blood sugar.
The subjection of any patient to general anesthesia poses a threat to life in general, but taking from a donor is only after a very deep study. In the event of a death due to a liver donation, according to Turkish laws, the center will be closed forever.
The duration of the operation for the donor is between 4-6 hours
The donor and the recipient can come with three people to Turkey for liver transplantation.
The success rate in liver transplantation in children is similar to that of adults, meaning it ranges between 85-90%.
Of course, liver transplantation can be done for cancer patients, as it is performed, unlike some European countries, even in the advanced stages, provided that there is no transfer of the cancerous tumor outside the affected tissue.
No, blood group compatibility is sufficient for liver transplantation.
It is very normal to feel tired in the first three months after surgery due to the increased energy your liver requires to reach its previous size. For this reason, those who work in jobs that require physical activity, can return to these jobs within 5-6 months at the earliest. Those who have clerical work and similar light tasks will return to these jobs within 3-4 months.
Although it varies with different centers, after discharge from the hospital, a blood analysis is performed on the 15th and first month of the operation and a USG sonogram in the third month. No additional revisions are required at a later time.
The universally accepted age of those who can donate a liver is limited between 18-60.