Kidney Transplantation

Kidneys are two small organs, each weighing around 110-150 grams, resembling brown beans and nearly identical to one another. These vital organs often go unnoticed unless they hurt or fall ill. However, they work tirelessly 24 hours a day to keep our health in check, enabling us to live a seamless life as long as they function properly.

Sadly, millions of people worldwide face diseases that impair kidney function every year. These conditions can negatively affect kidneys at any stage of life. Some infants even face severe consequences of such diseases while still in the womb. Whether young or old, everyone who loses their health shares one desire: to regain their former health or to lead a healthy life.

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For those suffering from end-stage renal disease, there is only one solution to regain their health: kidney transplantation. A transplanted kidney functions just like the patient's own kidney. For those unable to receive a transplant, dialysis offers a temporary solution until a suitable kidney is found. Studies reveal that kidney transplant recipients live longer and enjoy a better quality of life compared to those on dialysis.

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Why Aren’t Enough Kidney Transplants Being Performed ?

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The answer is simple: There aren’t enough organ donations!

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In Turkey, live organ and tissue transplants are strictly regulated by the Ministry of Health. According to these regulations, live organ and tissue transplants can only be performed from relatives up to the fourth degree by blood or marriage. For potential donors outside this scope, the decision is evaluated by ethical committees, and transplants are performed if deemed appropriate.

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The Turkish Civil Code defines kinship as follows: "In consanguinity, the degree is determined by the number of births linking the relatives to each other."

Protecting kidney health and understanding the importance of organ donation is a shared responsibility for addressing this critical issue.

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Live Organ Transplantation and Procedure

 

Live organ transplantation can be performed from a donor who is either a spouse living with the recipient for at least two years or a relative by blood or marriage up to the fourth degree. Additionally, individuals with no familial or kinship ties can donate organs. However, in such cases, detailed investigations and assessments are conducted in accordance with legal regulations.

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For non-relative live donors, an ethical committee must confirm that the donor-recipient relationship complies with regulations and is ethically appropriate. Both the recipient and donor must apply to the Provincial Health Directorate through the organ transplantation center to initiate this process. The ethical committee convenes every two weeks. Once approval is granted, preparations for the transplant are finalized.

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Importance of Blood Type Compatibility​​

For a kidney transplant, blood type compatibility between the donor and recipient is essential, similar to blood transfusion. Compatibility works as follows:

• Type O blood: Can donate kidneys to anyone (universal donor).

• Type AB blood: Can receive kidneys from anyone (universal recipient).

 

Patients without blood type compatibility may apply to the cross-donation registry for a potential match. Rh compatibility is not required in kidney transplants; for instance, a Rh-negative person can receive a kidney from an Rh-positive donor.

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Additionally, the donor and recipient undergo tissue typing. While tissue compatibility is not mandatory for kidney transplantation, it can improve post-transplant success rates. Lack of tissue compatibility does not prevent the procedure.

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What Donors Should Know​

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The process begins with evaluating the patient’s family and social history to identify potential donors. Donors with ABO blood type compatibility are selected for further tests, including tissue compatibility.

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A thorough medical examination ensures that donating a kidney poses no health risk to the donor. Any suspicion of potential harm disqualifies a candidate from donation. Donors also undergo psychosocial evaluations to confirm their readiness for organ donation. A suitable donor is chosen in collaboration with the patient and their family, and the donor is fully informed about the preparation process and the transplant surgery.

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The process typically follows these steps:

1. The donor’s surgery is performed first, lasting about 1-2 hours.

2. The recipient’s surgery begins approximately 30 minutes after the donor surgery.

3. The kidney is transplanted immediately after removal without delay.

 

Modern laparoscopic surgery allows for kidney removal through a small 5 cm incision in the groin area, hidden under the underwear line. This technique offers a quicker and less painful recovery for donors.

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What Is Cross Donation ?

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Cross-donation is a method for patients whose blood type is incompatible with their donor. People willing to donate despite incompatibility are paired with other donor-recipient pairs for matching.

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For example:

• A recipient with blood type A has a donor with blood type B, and another recipient with blood type B has a donor with blood type A. These donors swap recipients to ensure compatibility.

 

Patients with blood type O or AB have fewer opportunities for cross-donation due to their unique compatibility profiles. Ethical approval is mandatory for all non-relative cross-donations to ensure compliance with regulations and ethical standards.

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Who Cannot Be a Kidney Donor ?

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The following individuals are not eligible to donate a kidney:

• Those under 18 years old

• Hypertensive individuals (≥140/90 mmHg) or those on hypertension medication

• Diabetic patients

• Those with proteinuria (≥250 mg/24 hours)

• Individuals with recurrent kidney stones

• Those with low GFR (<80 ml/min)

• Those with microscopic hematuria

• Those with severe medical conditions

• Individuals with urological abnormalities in their kidneys

• Obese individuals

• Those with a history of thrombosis or thromboembolism

• Individuals with psychiatric disorders

• Those with strong family histories of diabetes, hypertension, or kidney diseases

 

Quick Recovery Through Laparoscopic Surgery

 

In our kidney transplant center, laparoscopic surgery is used to remove kidneys completely. Compared to open surgeries, this method offers several advantages:

• Smaller incisions (5 cm vs. 15-20 cm in open surgeries)

• Less postoperative pain

• Minimal scarring, which is more aesthetically pleasing

• Lower risks of complications such as infection, numbness, or hernia

 

Laparoscopic procedures allow donors to recover quickly:

• They can walk and drink water on the evening of the surgery.

• By the next morning, they can eat and take a shower.

• Most donors are discharged the day after surgery and can return to work within a week.

• Recipients are discharged about a week after the transplant.

 

Kidney Diseases

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When kidneys fail to function correctly, harmful substances accumulate in the blood, causing various symptoms. Acute kidney damage may be reversible, but chronic conditions often lead to irreversible consequences if untreated.

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Common kidney diseases include:

• Acute and chronic kidney inflammations

• Tubular diseases

• Congenital (hereditary) disorders

• Vascular kidney diseases

• Kidney stones

• Infections of the urinary tract

• Obstructions in the urinary tract

• Hypertension and diabetes-related kidney diseases

• Drug-induced kidney damage

 

Symptoms of Kidney Diseases​

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• Frequent urination at night

• Fatigue

• Shortness of breath

• Swelling in hands, feet, and eyes

• Hypertension

 

Post-Transplant Care and Recommendations

 

To maintain a healthy life after kidney transplantation, patients should follow these guidelines:

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• Rest Regularly: Get adequate sleep daily and maintain a balanced routine.

• Maintain Hygiene:

  • Clean your home, especially bathrooms and kitchens, thoroughly.

  • Shower frequently, using a liquid soap.

  • Replace towels regularly, and always wash hands before meals and after using the toilet.

• Protect Yourself:

  • Avoid crowded places for the first three months.

  • Use double masks on public transport.

  • Do not share personal hygiene items like towels, combs, or razors.

• Exercise Moderately: Avoid heavy lifting or strenuous activities for the first three months.

 

Dietary Recommendations​

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• Meals: Serve small portions and eat slowly.

• Salt: Reduce salt in cooking unless otherwise advised.

• Fats: Use healthy oils like olive oil instead of margarine.

• Water: Drink at least 3 liters daily.

• Food Choices: Opt for lean meats and fresh juices instead of processed or carbonated beverages.

 

Sexual Life After Transplantation

 

Post-transplant, most men and women experience an improvement in sexual health compared to dialysis periods. Hormonal balances normalize, restoring fertility in many cases. Women may resume regular menstruation, and men often see increased sexual strength.

In cases of reduced sexual health, treatments can address underlying issues effectively.

 

Returning to Work After Transplantation

 

Patients are advised to avoid crowded areas during the first three months post-transplant to reduce infection risks. Once fully recovered, and with their doctor’s approval, they can resume work or school. Social security benefits are critical as post-transplant medications can be costly.