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Organ transplant is the most useful form of end-stage organ failure treatment or the only treatment for some organs. In cases where an essential organ fails and it is not possible to restore its function, a transplant often provides the only chance of survival. Perhaps also a chance at a new outlook on life. Since the first successful kidney transplant was carried out by Joseph E. Murray in the US in 1954, transplant medicine has made such significant progress that many patients are able to improve their quality of life as well as their chance of survival. The success rates we see today are unquestionably a consequence of the development of modern immunosuppressants that prevent the body from rejecting the transplanted organ.

To prevent organ rejection after transplantation, the patients are often treated with immunosuppressive therapy that lasts a lifetime. Immunosuppressive treatment is used by combining several drugs that affect different points of the immune cascade.

Today we are able to successfully transplant the kidneys, liver, heart, lungs, pancreas and small intestine. In Turkey, there are 24,787 people are currently on the waiting list for a donor organ, of whom around 87% are awaiting a kidney and 9% are awaiting a liver.

(https://organ.saglik.gov.tr/0TR/70Istatistik/OrganNakilIstatistikKamusal.aspx).

 

In Turkey, organ donations and transplantations are carried out within the framework of the laws, regulations and legislation of the Ministry of Health.

 

 

Organs and Diseases

Kidneys

What do the kidneys do?

 

The kidneys are fundamental excretion organs in the body, located on the right and left side of our vertebrae, on the back wall of our abdomen and carry out the following functions to regulate body functions:

  •  Cleaning of harmful and waste materials by producing urine,
  • Regulation of the body's salt and water levels and blood pressure,
  • Hormone production and release,
  • Control of the production of blood cells

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Kidney Failure

Kidney Failure can have a wide range of causes. These can be sorted as; inflammation of some parts of the kidneys, inflammation of the parts of the kidneys that are responsible for filtering the kidneys, diabetes, kidney cysts, high blood pressure, decreased blood flow to the kidneys due to damage to some of the blood vessels leading to the kidneys.

Kidney failure come through itself both acutely and chronically.

Acute kidney failure is a kidney failure which the kidneys take a very short break in their work and the return can be achieved. If the patient is treated with early diagnosis at the right time, the kidneys of the person can continue to function normally.

In chronic kidney failure, the conditions become more serious.

Possible symptoms of kidney failure include:

* Reduced amount of daily urine or excessive urination,

* Shortness of breath, palpitations,

* Having a yellowish-brown color in the skin,

* Loss of appetite, weakness,

* Blood pressure increases,

* Irregular heartbeat,

* Significant accumulation of water on the eyelids, feet,

* Painful urination,

* Blurred, bloody urine,

* Getting more than one at night's toilets,

* Mental fog, convulsion,

* Itching and cramps.

 

In spite of appropriate measures and treatments in patients with severe kidney failure, excess fluid and waste substances accumulating in the body are cleared through a semipermeable membrane and the process is called dialysis. There are two different types of dialysis treatment.

  • Hemodialysis
  • Peritoneum Dialysis

 

Liver

What does Liver do?

The liver is the largest gland in the body and the main organ responsible for our metabolism. It works to break down and eliminate substances, produces essential proteins, utilizes food components and regulates metabolic pathways.

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Liver Disease

The liver is highly resilient and is able to keep working even when it is partly damaged. It also has a good ability to repair damage and balance out a loss of tissue, as long as it is not too extensive. Once the liver is damaged it forms scar tissue, which gradually replaces the normal liver tissue as the disease progresses. If the liver is damaged or the damage show continuity due to various diseases, the structure of the liver tissue gradually begins to deteriorate because of scar tissue. This obstructs the blood flow and the liver is no longer able to function as required. This is called cirrhosis of the liver. It is most often caused by drinking too much alcohol or by chronic hepatitis C. There are also a number of autoimmune diseases, metabolic disorders and other genetic diseases, such as cystic fibrosis, that can damage the liver.

Possible symptoms of progressive liver disease include:

  • Fatigue and a reduced capacity for physical exercise
  • Loss of appetite, dizziness, weight loss
  • Changes in the skin (e.g. increased dilation of the blood vessels in the skin), itching
  • Fluid retention in the abdomen
  • Varicose veins in the oesophagus and stomach
  • Diminished brain capacity

After cirrhosis develops, it is not possible to reverse it with conventional treatments. Eventually, the disease ends with liver failure. The only known treatment at this stage of the disease is liver transplantation.

 

ORGAN DONATION

Waiting for a new organ

The basic prerequisite for a successful transplant is that a suitable donor organ is available.

Organ Transplantation

What happens during the operation

Once an organ on the waiting list becomes available, things have to move incredibly fast. For a post-mortem donation, typically only a few hours pass between the notification that an organ is available. As a result, it is important for potential organ recipients to be easily reachable at all times. Additionally, patients should be prepared for a longer stay in hospital.

For kidney transplants there is more time available for the preparations than for other organs. 36 hours are allowed to pass between the organ being recovered and being transplanted. A liver must be transplanted within 8 to 9 hours.

The hospital then carries out a number of tests to make sure that the transplant will not negatively affect the patient's state of health. The patient takes a number of medications before the operation. These suppress the body’s natural immune response to reject foreign organs – they are called immunosuppressants.

Kidney Transplants

In kidney transplants, the patient’s own non-functioning kidneys are often left inside the body. The donor organ is transplanted into the lower abdomen and then connected to the major blood vessels in the pelvis. To ensure that urine can flow out of the new kidney, the ureter is sewn into the bladder. This connection is often stabilised using a special catheter that can be removed a few weeks after the transplant.

 

Liver Transplants

With the exception of very few metabolic diseases, the recipient’s original liver is always removed in its entirety during a liver transplant. However, the transplanted organ in this case can be either a complete liver or part of a liver. Partial organs grow back to their original size in the space of a few months. The donor organ is inserted in place of the recovered organ and is then connected to the relevant structures.

 

Immunosuppression

During the period immediately following the transplant, it is necessary to carry out frequent and regular checks to see how the body is coping with the new organ. Despite the donor and recipient having compatible blood groups and high matches in terms of tissue markers, the body still recognizes the new organ as being “foreign”. Our natural immune response can result in the transplanted organ being rejected. To prevent this, the patient must take medications to suppress their body’s immune response.

These medications, called immunosuppressants, are given before and during the operation, and the patient will need to take them for life according to very precise dosing instructions. If the patient does not take their medication regularly or stops taking it without their doctor’s approval, it can put the transplanted organ at risk and can lead to a short- or long-term decline in function, and potentially to complete failure with loss of the organ.

 

Lıfe After A Transplant

The new organ

The patient has had a successful transplant operation. But what happens next? What happens whilst the patient is in hospital, and later on when they are back at home?

 

The First Few Days

Immediately following the transplant operation, both the patient and the function of the new organ are closely monitored in intensive care.

 

Day to Day Life

Counteracting organ rejection

The most feared complication after a transplant is rejection of the donor organ. So how do we recognise when an organ is being rejected? The earlier that we can identify a rejection response, the lower the risk of losing the transplanted organ.

Signs of rejection can vary depending on the organ. Generally speaking: if one or more symptoms occur then the patient should immediately visit the doctor responsible for their treatment or the transplant aftercare centre. Failure to initiate appropriate treatment quickly can lead to organ loss in just a few days. If rejection responses are identified early on then they usually respond well to treatment with drugs.

 

Possible Signs of Kidney Rejection

The following can be signs of a rejection response to the kidney:

 

  • Significant drop in urine output
  • Weight gain due to fluid retention (oedema), especially in the legs
  • Increased blood pressure due to higher volume of fluids in the body
  • Poor general condition
  • Increased body temperature
  • Swelling of the transplanted organ, in certain circumstances accompanied by pain

 

Possible Signs of Liver Rejection

The following can be signs of a rejection response to the liver:

  • Weakness, easily fatigued
  • Body temperature rises over several hours
  • Loss of appetite
  • Abdominal pain
  • Fluid retention in the abdomen
  • Swelling of the transplanted organ
  • Clay-coloured stools, dark urine

Yellow tinge to the sclera and the skin