Organ Transpaltation

What is the liver and what vital functions does it perform?

The liver is an organ located in the abdominal cavity to the right of the hypochondrium. It is the biggest gland in the human body, and weights around 2.5% of an adult (around 1.5 kg). Blood detoxification, the synthesis of the most important substances of the blood, glycogenesis, and bilifaction are carried out in the liver. It is also involved in lymphogenesis and the body’s metabolizing process. The most important functions of liver:

• bile production (circa 600 ml a day);
• detoxication;
• ​detoxication and elimination of excessive agents (hormones, vitamins), of metabolic-waste products;
• hormones level regulation (e.g.: aldosterone, epinephrine (adrenaline), estrogen, insulin);
• participation in digestion;
• conversion of ammonia into urea;
• energetic reserves storage (glycogen);
• carbohydrate metabolism;
• accumulation, storage and delivery of certain vitamins;
• participation in vitamins metabolism (folic acid, А, С, В, D, К, E, РР); conversion of carotene into vitamin A;
• lipid, cholesterol synthesis, lipid metabolism regulation; fat energy restoration;
• synthesis of ferments, hormones which participate in food transformation;
• detoxication of endogenous and exogenous agents (alcohol, toxins, drugs);
• participation in immune functions;
• an important role in blood circulation;
• thermoregulation of body;
• plasma proteins and blood-coagulation factors production.

If the liver stops functioning properly, the problems associated with this may include:

• A disorder of the digestive function of the liver, resulting in a reduced level of bile secretion, can lead to changes to the shape of the organ and an interruption to the normal digestion and absorption of fat in the gastrointestinal tract. This may result in diarrhea and flatulence, and the lack of fat absorption may lead to metabolic alterations, followed by weight loss and even cachexia (muscle loss).
• An interruption to the detoxification (decontaminative) function of the liver cam lead to the blood being impacted by the presence of toxic agents both from outside the body and from those produced by microflora like indole, phenol, or skatole in the large intestine. The presence of these toxins in the blood can produce irreversible damage to the central nervous system including the brain through a process called liver encephalopathy.
• ​Impacts on the liver’s synthetic ability can lead to albumin synthesis inhibition. Albumin is the most important plasma protein. Furthermore, the production of blood-coagulation system proteins can be reduced, eventually resulting in hemostatic derangements that result in even minor injuries producing prolonged bleeding.

Liver disorders are particularly important to address since they quickly become chronic without the necessary treatment, resulting in irreversible damage and ulterior functional abnormality. Despite modern medicine’s achievements, some liver disorders do not respond to treatment short of transplantation. It can be the only option in some advanced or severe liver pathologies.

The kidneys are the most important paired organs of the human urinary tract system, and they handle both urine production and the filtration of blood plasma. Human kidneys secrete around 1 to 1.5 liters of urine a day, and one kidney weights between 120g and 200g. They are located in the retroperitoneal space to the right and left of the spine. The most important functions of kidneys:

• purification of blood plasma from nitrogenous metabolic products (urea, uric acid, creatinine);
• removal from the body of foreign toxic molecular entities (e.g.: the release of substances formed as a result of drugs breakdown);
• maintaining a constant volume of intercellular fluid in organs and tissues, which is a key part of ‘homeostasis’ and supports the normal function of the entire body;
• maintaining a constant concentration of electrolytes, such as sodium, potassium, magnesium, chlorine and calcium;
• regulation of blood pressure (it is for this reason that heart diseases can result from diseases in the urinary system);
• participation in the metabolism of proteins, carbohydrates and lipids. In the process of reverse filtration these compounds are reabsorbed from primary urine;
• participation in hematopoiesis (erythropoietin).

If the kidneys stop functioning properly, this results in the imbalance and disorder of vital activities throughout the entire organism, and also leads to an elevated level of blood toxins. Kidney disorders require immediate treatment because, without the necessary treatments, they quickly become chronic, causing irreversible damage and resulting in ulterior functional abnormalities. Some kidney disorders can only be cured by organ transplantation. A kidney transplant is a surgical operation which transplants a kidney into the patient (recipient) from the body of another human (the donor). Such an operation is meant to be used as a method of substitutive renal therapy at the end-stage of chronic kidney diseases when the condition is impossible to cure without a transplant.

Indications for kidney transplantation:

• glomerulonephritis;
• chronic pyelonephritis (reflux nephropathy);
• hereditary kidney diseases;
• congenital kidney diseases;
• metabolic kidney damages;
• obstructive nephropathy;
• toxic nephropathy;
• ​systemic diseases;
• hemolytic-uremic syndrome;
• kidney tumors;
• irreversible kidney disease;
• kidney injury.

Contraindications to kidney transplantation:

• The donor is not a good immunological match for the recipient. This can be tested through observing lymphocyte reactions, with a negative result indicating that the kidney will inevitably be rejected.
• There have been malignant tumors in the kidneys or other organs in the last two years, or there has been a treatment for tumors in the cervix, breast or a melanoma treatment in the last 5 years. The exceptions to this are in the case of asymptomatic kidney tumors which were effectively treated, after which there needs to be no wait time before the transplant.
• Presence of infection in the body (except of hepatitis С and B).
• Chronic diseases being present in any other organ, such as in the cases of heart failure, peptic ulcers, diabetes mellitus.
• Unwillingness to follow the doctor’s instructions. After kidney transplantation, you will need to take certain medications in a timely and regular manner, and an inability to do this will result in the transplanted kidney being rejected.
• Psychological conditions which involve personality changes (schizophrenia, epilepsy, alcoholism, drug addiction).

How does a kidney transfer happen?

A kidney transplant consists of both a donor and recipient stage:

Donor stage – stage of donor selection

The process of donor selection is carried out. This may involve the relatives of the recipient, providing they have two healthy kidneys and do not have any infectious diseases (such as hepatitis or HIV). Regardless of who the donor is, the blood group, genetics, age and other criteria are checked for suitability. Should the kidney be considered a likely good match, it is recovered laparoscopically with minimal trauma and a consequently rapid rehabilitation process.

Who can be a kidney donor?

In Turkey both relatives and non-related people can be considered for voluntary organ donors. They may opt to donate either a part or a whole organ, depending on the recipient’s need and the donor’s situation and willingness.

Your Journey

A personal assistant supplied by Safe Med Clinic’s Assistance will welcome you at the airport, accompany you to the hospital and do the necessary translation in order to guarantee a worry-free medical trip experience in Turkey.  

Recipient stage

The transplantation itself is carried out at this stage.

Preoperative stage and diagnostics

Before the kidney transplant, the recipient and the donor undergo an extensive examination and a detailed assessment of tissue compatibility to minimize the chance or a rejected transplant. This process of assessment will involve: Professional consultation Laboratory tests

• blood group, Rh factor;
• (complete and biochemical) blood tests;
• screening for viral and bacterial diseases;
• coagulogram;
• serologic assay.

Instrumental methods of diagnosis

• ultrasonography and kidney Doppler sonography;
• X-ray of kidneys and urinary bladder;
• biopsy;
• urodynamics;
• ECG;
• CT;
• 24-hour blood pressure and ECG monitoring (donor over 40 years old).

Transplant operation:

For a few days before the transplantation, patients are recommended to follow a special diet. All operations are performed under general anesthesia. The donor kidney is then removed by open (laparoscopic) surgery. This operation lasts between 3 and 8 hours. In the recipient, incisions are made for access, followed by the placement of the donor kidney into the iliac fossa. At this stage, anastomoses (connections) are formed between the kidney vessels and the iliac vessels, and either a donor ureter is implanted into the bladder or an anastomosis (connection) with the recipient’s original ureter is formed. In nearly all cases, the recipient’s original kidneys are not removed. After the kidney is transplanted, the surgical wound is sutured layer by layer, and a cosmetic stitch is applied to the skin.

What is bone marrow and what vital functions does it perform?

Bone marrow is one the most important parts of the body for hematopoiesis (the process of producing new blood cells as old ones die or denature). It is also involved in immunopoiesis (immune cell production). Bone marrow is the only tissue of an adult human which contains large numbers of immature, undifferentiated and low-differentiated cells known as stem cells, which are structurally similar to embryonic cells. The total bone marrow mass in the adult body is between 1.6 kg and 3.7 kg, with an average of around 2.6 kg.

The main functions of bone marrow are:  

• formation and maintenance of immunobiological processes;
• bone formation;
• participation in the exchange of proteins, fats, carbohydrates and minerals;
• production of protein bodies, synthesis of cholesterol and ascorbic acid;
• participation in the metabolizing of iron;
• the formation and storage of blood (on average, the process of hematopoiesis takes between 3 and 7 days)

When there is a pathology of the bone marrow, this affects hemopoiesis (blood formation) and immunopoiesis (immune cell formation), and without necessary treatment, this can lead to irreversible functional abnormalities in organs, organ systems and in the bone marrow itself. Hematopoietic stem cell transplantation (HSCT) is a method of treatment used in hematology and oncology for the treatment of diseases of the blood and bone marrow, as well as some other diseases. In daily life, the term ‘bone marrow transplantation’ is commonly used. Hematopoietic stem cells can be found for transplantation from a variety of sources, including from the bone marrow itself (BMT), from the blood (PSCT) or from blood from an umbilical cord. There are three types of bone marrow transplantation:

• bone marrow transplantation (BMT);
• peripheral stem cell transplantation (PSCT);
• umbilical cord blood transplantation.