Organ transplantation implies transferring organ of a healthy donor under medical conditions to replace the dysfunctional organ in human body. It is one of the fast-growing disciplines in the medical community, and recently, medical and technological developments made this advanced level treatment modality routinely performed for acute (only for acute failure of liver) and chronic organ failures. In short, organ transplantation is a life saving surgery with any and all advantages (in terms of quality of life and life span) clearly revealed out. Many patients cherish the hope for this treatment modality that is regarded as the medical miracle of 20th century and also recognized by patients, but the only problem is the scarcity of organs.
Kidney is the most commonly transplanted organ worldwide. Chronic renal failure is mostly secondary to diabetes mellitus and hypertension and half of patients, who cannot grab chance of transplantation, die within 5 years, and this mortality rate is far worse than many other cancers. We need to enable such patients access to transplantation based on the principle “the worst organ is better than the best dialysis”. Patients with medically approved living donor can grab a chance of transplantation. The other most commonly transplanted organ is liver. Although there are many causes of chronic liver disease, most common ones include viral hepatitis, alcohol consumption and some metabolic diseases as well as biliary atresia in children. On the contrary to dialysis therapy for renal failure, a patient with totally dysfunctional liver has no other treatment option. The only remedy is the liver transplant surgery or otherwise, the patient will die within a short time. Therefore, number of patients waiting for liver transplantation is far lower than patients waiting for donor kidney.
Death of the cadaver organ donor is medically approved by two authorized physicians at intensive care conditions. Even if the donor has a tissue and organ donation certificate before death, organ donation requires written consent of two relatives, who are available at the time of death. Although use of cadaver as source of organ is a medical necessity, living donors come into play when cadaver organs cannot meet the demands, but the supply cannot meet the demand in our country and the need increases day by day. Since the organ supply deficit is continuously increasing, it is not legally appropriate to transplant cadaver organs to citizens of other countries.
This shortness of organ donation is not only faced in our country, but it is also a global problem. Therefore, waiting lists are ever increasingly get longer, as the supply cannot fulfill the demand. Waiting period exceeds 10 years for renal transplantation even in developed countries. Dialysis methods can enable survival for patients with renal failure and they may stay in waiting lists for a long time. Moreover, many patients on waiting lists of heart, liver and lung die due to failure to find an organ in a timely manner, as there is no other treatment option. Living donor transplantation is a chance only for kidney and liver transplant surgeries.
Although there are variations between countries regarding the living donors, there are strict criteria in our country. The first rule of being an organ donor is to be voluntary. In Turkey, any healthy person legally aged 18 or older with sound mental capacity (approval of spouse is required, if donor is married) can donate organ to relatives up to 4th degree, if the donor signs organ donation document before minimum two witnesses and the donation request is approved by the doctor. However, non-related donors are discussed in ethics committees that are organized in cities, and transplantation is performed, if positive result is obtained. Non-related organ donation is strictly forbidden, if life of organ donor is threatened or ceases, or if organ donation is medically contraindicated or if ethics committee does not approve the donation. On the other hand, if these criteria are met, organ transplant surgery can be carried out in state and privately owned healthcare facilities that are licensed by Ministry of Health and have specialized personnel, instruments and equipment for this surgery.
Dr. Dinçkan says “As a result of increased life expectancy and advanced technology, medical community regards increasingly more patients as a good candidate of organ transplantation, translating into increased number of transplant surgeries”. Turkey comes to the forefront among countries of the region with the quality and sustainable healthcare service in the field of organ transplantation. Globally, Turkey ranks second country in living donor liver transplant surgeries and seventh country in renal transplant surgeries. All organ transplantation centers are administered and audited by a central organization. In Istinye University Organ Transplantation Center, where liver, kidney and pancreas transplant surgeries are carried out in high numbers, professional training in the field of organ transplantation are available for both local and international physicians.
Prof. Ayhan Dinçkan, M.D., Head of Organ Transplantation Center of Istinye University, says “we should increase number of organ transplantation for the sake of humanity”. Because thousands of patients wait in hope for this treatment - the only chance of survival. Because the number of patients with no other treatment option is increasing. Because our pediatric patients, who wait for organ, need organ transplantation to hold onto the life, grow and develop and continue education as well as get pleasure out of life. Because the life expectancy is almost above two folds in kidney transplantation comparing to other treatments. Because quality of life does not differ from any healthy person. Transplant patient can marry, give birth and work to contribute to the state economy. Because getting healthy with transplant surgery is one third cheaper relative to expenditures to treatment of renal failure – that accounts for 5% of overall health expenditures. In addition to therapeutic advantage, other cost advantages include productivity and absence of labor loss.
Finally, it is worth to mention that Each donated organ means a human who holds onto life.
Prof. Ayhan Dinçkan, M.D.
Liv Hospital, Istinye University
Head of Organ Transplantation Department