Donor Information Guide

Donor Information Guide

Organ transplantation is today regarded as a routine, established and advanced treatment method used in many chronic organ diseases.

Liver transplantation can be performed in two ways:
• Deceased-donor liver transplantation
• Living-donor liver transplantation

Living-donor liver transplantation is performed by transplanting a part of the donor's liver, in a way that does not put the donor's life at risk.
Kent Hospital, which supports organ donation, treats patients with social security coverage at its SGK-contracted Liver Transplant Center with the comfort of a private hospital.
The Kent Hospital Liver Transplant Team has specialized in liver transplantation for 20 years and has so far performed liver transplants on more than 2,000 patients.
If you apply to our center for a liver transplant, your pre-operative tests are completed within a very short time, and all hospital staff help you regain your health without waiting in line.

ABOUT YOUR LIVER
The liver, the largest and most important solid organ of the body, has many vital functions, each as important as the others. Of its countless functions, 4 are particularly important.

1. Selecting and storing the substances the body needs from the food we eat, and producing the proteins required to maintain the normal vital cycle
2. Producing the bile acid needed to digest food and delivering it to the digestive system
3. Clearing harmful substances produced by other systems in the body
4. Producing the factors needed to fight infection and to stop bleeding anywhere in the body.
 

WHAT IS LIVING-DONOR LIVER TRANSPLANTATION?
Living-donor liver transplantation is a complex surgical procedure in which a part of the liver taken from a living donor (provided that a sufficient amount of liver remains for the living donor) is placed into the recipient.
 

WHY ARE ORGAN TRANSPLANTATION AND LIVING DONORS NEEDED?
Thousands of patients diagnosed with end-stage liver failure are waiting for a liver transplant on the National Organ Waiting List. Unfortunately, not enough organs can be found for all patients.

According to the June 2006 UNOS (United Network for Organ Sharing, the American national waiting list) data, while 17,645 patients were waiting for a transplant, only 6,000 of them were able to receive one. Approximately 50% of the patients on the waiting list die while waiting for an organ, while new patients are added to the list every day. With living donors, the organ shortage and mortality rates can be reduced.

WHAT ARE THE ADVANTAGES OF LIVING-DONOR LIVER TRANSPLANTATION?
• Short waiting time: The loss of patients on the waiting list is reduced, and suitable conditions are provided for the recipient to undergo surgery under the best possible circumstances.
• It makes it possible to transplant the most suitable organ.
• Being able to perform the surgical procedures under elective conditions keeps the success rate of the transplant at the highest level.

The average one-year survival chance of patients who develop end-stage liver failure is around 50%, and this rate can fall even lower with complications. It has been shown that the worse a patient's condition at the time of transplantation, the shorter their survival and the harder their post-operative period. For this reason, appropriate timing and appropriate patient selection become even more important for achieving encouraging results.
 

BASIC PRINCIPLES
• The recipient candidate must accept living-donor liver transplantation.
• Every recipient for whom donor preparation has begun is also registered on the deceased-donor waiting list. Preparing a living donor does not affect the recipient's position on the deceased-donor list. Organs obtained from deceased donors are offered according to the recipient's priority on the National Organ Transplant Waiting List, regardless of whether the recipient has a potential living donor.
• Donors must be people aged 19-50 (having completed the age of 18), of sound mind, with no health problems.
 

A point not to be forgotten!
The main motivation of donors is the desire to be able to help the recipient. For this reason, donors must make their decisions of their own free will, free from any kind of insistence such as outside pressure, coercion or threats.

During the evaluation, donor safety is the most important element for the entire transplant team. If, during the clinical examination and laboratory tests performed on the potential donor candidate by the transplant team, any finding is encountered suggesting that harm could come to them, the tests are stopped at that stage. The preparation period can take days, weeks and sometimes months, depending on the donor's health and the urgency of the recipient.

If there is more than one donor candidate, the candidates are ranked in light of the clinical examinations and laboratory tests, and testing begins with the most suitable candidate. Our main goal is for the donor to trust the team, to ask all the questions on their mind and to receive answers to them. All information obtained during the evaluation is kept strictly confidential and will not be shared with third parties.

All of the donor's expenses related to living liver transplantation are paid by the recipient's health institution. This includes all pre-transplant tests of the recipient and the donor, and all examinations and treatments performed during the hospital stay, including the surgery fee. For check-ups and tests to be performed on the donor after discharge, the donor's social security coverage applies.

According to the regulation that entered into force with the approval dated 28.06.2004 and numbered 4690 of the Ministry of Health of the Republic of Türkiye, organ and tissue transplantation from living persons can be carried out from the recipient's blood relatives and relatives by marriage up to the fourth degree (fourth degree included).

Regarding fourth-degree kinship: Article 17 of the Turkish Civil Code states, “The degree of blood kinship is determined by the number of births linking the relatives to one another.”

Accordingly, in blood kinship, relatives are classified by degree as follows:

1st-degree relatives: Mother, father and child
2nd-degree relatives: Sibling, grandfather, grandmother, grandchild
3rd-degree relatives: Paternal uncle, paternal aunt, maternal uncle, maternal aunt, nephew or niece (a sibling’s child)
4th-degree relatives: The children of those in the 3rd degree.

In affinity (kinship by marriage), the relatives on the spouse’s side are graded in the same way.

When deciding whether to accept or decline a potential donor candidate, the doctors and members of the transplant team also take their own ethical and moral responsibilities into account. The transplant team is under no obligation to perform every living-donor operation. In unusual ethical matters, the recommendations of the Transplant Ethics Committee are also sought.

Only 20% of the candidates who apply to become a liver donor pass all of the stages and are able to become a living donor.

The most common reasons for not proceeding to surgery are an unsuitable vascular anatomy, abnormal blood tests, and medical problems that had not been identified before and are detected at that point.

Donor candidates have the right to withdraw their voluntary participation at any time, if after the preparation has begun they decide that living donation is not right for them.

Donor candidates and their decisions are always respected and supported to the very end. Information is not given to recipients unless the donor specifically requests it, and every effort is made to protect donor safety to the highest degree. Donor candidates should contact us directly with all their questions and concerns about any stage. Information about the donor will never be given to third parties (family members, friends, recipients, etc.).

If you would like to speak with a patient who has had a living-donor liver transplant, or with their donor, we would be happy to help you with this.
 

WHAT ARE EMERGENCIES? DOES THE RISK INCREASE?
Emergency living-donor liver transplantation applies only in exceptional circumstances. It is generally considered in adults who develop acute liver failure that could lead to death within a few days, or in children whose liver function is deteriorating rapidly. Potential donors must fully understand and accept that transplants performed in emergencies may carry markedly higher risks than transplants performed under the most favorable conditions, known as “elective” transplants. (For example, increased pneumonia – a lung infection – because there was not enough time to quit smoking, or increased blood-clotting problems because birth control pills could not be stopped in good time.)
 

WHO CAN BE A DONOR? WHAT ARE THE REQUIREMENTS FOR BECOMING A DONOR?
First of all, people whose blood group is compatible with the patient’s and who are related to the patient or have any kind of emotional bond with them can become donors. Because a donor candidate faces major surgery, they undergo a series of health checks. The donor must be completely healthy.
 

WHAT QUALITIES ARE SOUGHT IN A POTENTIAL DONOR CANDIDATE?

Voluntariness Is the Essential Element!
• The recipient and the donor must have compatible blood groups. (See the table.) • Rh factor compatibility is not required for the donor candidate.
• They must have no physical or psychological problems.
• Candidates must be between 19 and 50 years of age.
• Donors must be within the normal or near-normal range on the body mass index chart.
 

ARE THERE FACTORS THAT PREVENT SOMEONE FROM BECOMING A DONOR? IF SO, WHAT ARE THEY?
• Those with hepatitis B or C • Substance addiction, such as alcohol and drugs
• HIV infection
• Those with cancer
• Those with a psychological illness that has not been treated or cannot be treated
• Unusual vascular pathologies (that make surgery impossible)
• Diabetes mellitus, hypertension
 

HOW IS DONOR PREPARATION CARRIED OUT? WHICH STAGES MUST A DONOR CANDIDATE GO THROUGH?
STAGE 1: MEETING AND CLINICAL EXAMINATION This takes place when a doctor from the organ transplant team meets the donor candidate.

STAGE 2: BLOOD TESTS AND ORGAN FUNCTION TESTS The blood tests include liver function tests, kidney function tests, blood counts, and blood tests screening for diseases that may be present (for example hepatitis, cancer, etc.). A chest X-ray (PA – lateral) and an electrocardiogram (ECG) are taken if the candidate is over 45. If these values are normal, the donor candidate is taken into consideration.

STAGE 3: CONSULTATIONS At the first stage, consultations are requested from psychology, internal medicine, cardiology, chest diseases and, for women if deemed necessary, the obstetrics and gynecology outpatient clinics.

Candidates in whom no problem is found at these 3 stages move on to the 4th stage.

STAGE 4: RADIOLOGICAL IMAGING METHODS A specialized computed tomography scan is performed on the donor candidate. The candidate’s liver volume is calculated from the CT scan. For a donor candidate to be accepted, the amount of liver remaining after the operation must be adequate for their later life, and at the same time the amount of liver they will give to their relative must be sufficient for the recipient.

STAGE 5: ADDITIONAL PROCEDURES If it is deemed necessary after all these tests and imaging studies, a liver biopsy is performed. The biopsy is used to assess criteria such as any fatty change in the liver.

STAGE 6: THE MOMENT OF DECISION Finally, if the donor candidate is accepted following the council held by the organ transplant team doctors, the date of the operation is set.
 

WHAT HAPPENS THE NIGHT BEFORE THE OPERATION?
• Fasting: The patient is kept fasting after 24:00. From that time on, eating or drinking anything is forbidden. (Complete fasting)
• Shaving: The area from below the chest down to above the knees is shaved.
• Bathing: After shaving, a bath with chlorhexidine is given. (The body is washed from the neck down.)
• In the morning the patient is dressed in an operating gown.
• Then both the donor and the recipient are taken into the operating room.

Note:
• Alcohol use must be stopped at least 4 weeks before surgery.
• Smoking must be stopped at least 2 weeks before surgery.
• Birth control pills must be stopped at least 4 weeks before surgery.
 

WILL I RECEIVE BLOOD DURING THE OPERATION?
The answer is most likely no. Our hospital secures sufficient blood for patients from the Turkish Red Crescent (Kızılay).

Donors are asked to be in the hospital one day beforehand. The following day they are prepared for the operation.

During the operation, the bile ducts and vascular structures are carefully examined with the help of ultrasonography and cholangiography. After the gallbladder has been removed, the surgeon exposes the feeding veins and bile ducts of the portion to be taken from the liver (see the diagram on the back page).

In some cases, vascular or bile duct abnormalities that endanger the donor’s life, and that could not be detected despite detailed pre-operative tests, may be found during the operation. If such a situation is encountered, the donor operation is stopped. This situation occurs in approximately 1–2% of cases.

FOR ADULT RECIPIENTS, THE DONOR’S
right lobe of the liver, labeled 5, 6, 7, 8 in the figure, is taken.

FOR INFANT RECIPIENTS
The left lateral segment of the liver, labeled 2, 3 in the figure, is taken.

FOR CHILDREN AND ADULTS
The left lobe of the liver, labeled 2, 3, 4 in the figure, is taken.

THE OPERATION
TAKES APPROXIMATELY 4 – 6 HOURS FOR THE DONOR
AND 8–10 HOURS FOR THE RECIPIENT.
 

ARE THERE POTENTIAL RISKS OF LIVING-DONOR LIVER TRANSPLANTATION?
Provided that it is performed by a qualified and experienced team, donor surgery carries no different risk from other operations. However, recipients and donors must be well informed about the benefits and harms of the recipient and donor operations and about the problems that may arise from the surgery. During the pre-operative check-ups, the surgeon shares this information with the recipient and the donor. The recipient and donor should feel at ease during these discussions and should be sure to ask the team any questions that come to mind.

As in any operation performed under general anesthesia, events affecting the cardiovascular system (arrhythmia, etc.) and the respiratory system (pneumonia, etc.), referred to as complications, may develop. The living-donor team will explain these to you in detail.

Some of these complications are:
• Anaphylactic (allergic) reaction to anesthesia and blood products
• Heart attack at any point during the operation
• Pulmonary embolism
• Fluid accumulation in the lungs
• Fluid collection throughout the body (edema)
• Infection

Although the rate of complications related to the donor operation is minimal, the main complications are:
• For a living donor there is a 1% risk of death.
• In those from whom the right lobe of the liver is taken, the risk of death is 2 times higher than in those from whom the left lobe or left lateral segment is taken.
• Incompatibility between the transplanted organ and the recipient’s tissues
• Psychological trauma (if the recipient is lost) For the recipient there is a risk of death of around 10%.
• Incisional hernia (a hernia at the site of the abdominal wound)
• Digestive complaints (indigestion, constipation, nausea, etc.)
• Bleeding
• Bile leakage from the remaining liver portion
• Temporary jaundice
• A permanent scar
 

WHAT ARE THE COMPLICATION RATES?
DONOR OPERATION

The operation lasts about 4 to 6 hours on average. During the operation, on average 1 or 2 units of blood are needed. A complication that may be seen in the early period is atelectasis. The most common complications and their rates are:

• Rate of return to the operating room because of bleeding after the operation: 3%
• Rate of bile leak that can be treated endoscopically: 1.8%
• Rate of intra-abdominal collection requiring drainage: 3.6%
• Rate of developing pulmonary embolism: 1.8%
• Rate of operating on a hernia that develops at the incision site: 2.2%
 

WHAT HAPPENS AFTER THE OPERATION?
After the operation, donors are monitored in the operating-room intensive care unit. They are usually moved to a standard ward room on the 2nd or 3rd day. A ban on visitors is unavoidable. For a donor who has undergone major surgery, any infection coming from outside can cause life-threatening problems.

For the first 24 hours donors are kept on absolute bed rest (this can sometimes extend to 48 hours). During this time the donor must not get out of bed in any way, and must not even raise their head.

The main problems encountered in this period are pain at the surgical site and back pain. When you have pain, please do not hesitate to report it; it will be treated immediately. Loss of appetite, nausea and a sensation of bad smells in the period after surgery are complaints that occur after most liver operations. Please report any such complaints to the relevant team.

When you wake up you will have a urinary catheter so that you can empty your bladder, and there will also be 1 or 2 thin tubes (drains) at the surgical site. These are placed to remove fluids that collect inside during and after the operation, and they will be removed when the amount of fluid draining out decreases.

Every treatment and procedure performed on you will be carried out by the experienced doctors and nurses who make up the organ transplant team. Please do not worry about this.

You will be discharged after an observation period of approximately 1 week to 10 days. During this time, all of your treatment and monitoring will be carried out daily by the living-donor team. If, after the blood tests and other follow-up checks, there is no problem, you will be able to be discharged.
 

FREQUENTLY ASKED QUESTIONS
1 - How much of my liver will be taken?
The portion to be taken and its proportion will be determined after the computed tomography scan. However, there are two important concepts. The first is that the remaining liver volume must be left in such a way that it does not threaten the donor’s life, in other words that it meets the donor’s needs. The other requirement is that a piece of liver large enough to meet the recipient’s needs must be taken. These two factors are evaluated together by the whole organ transplant team at the council, and a decision is made without putting the donor or the recipient at risk.

In summary, from a donor candidate who will give a part of their liver to an adult recipient, approximately 50–60% of the liver is taken. Depending on the structure of the right lobe, this proportion can rise to 70%. From the donor of an infant or a very low-weight recipient, approximately 20% of the liver is taken.

2 - Will the remaining part of my liver be enough for me? Will the remaining liver be as large as before?
The remaining part of the liver is sufficient for a healthy individual, without endangering their life. The liver reaches approximately its former size after a period of about 3 months. However, the fastest growth takes place within the first 10 days after the operation.

3 – How long until I can return to work and my normal life?
While the liver is growing back to its former size, it is completely natural to feel tired during the first 3 months after surgery because of the energy and resources it uses.

For this reason, it should be known that donor candidates in heavy-labor jobs, or jobs that depend on physical activity, can return to such work in 5–6 months at the earliest, while those with desk jobs can return in 3–4 months. Especially during the first 6 months, they must not lift more than 2–3 kg. This is absolutely necessary both because of its relation to physical fatigue and in order to protect against hernias that can form at the surgical site. Apart from this, you can comfortably carry out your daily activities yourself after about the 1st month.

4 - When will my skin stitches be removed?
The timing of stitch removal depends on wound healing. After the skin stitches have been checked by the donor team, if wound healing is complete, they are removed at the time of your discharge or within the period described to you. (Usually 15 days after the date of surgery)

5 - When can I bathe?
After discharge, you can bathe in the manner of a shower (so that cleansing solutions do not come into contact with the wound).

6 - For how long do I need to have my dressing changed?
After discharge, you do not need to have your dressing changed unless the organ transplant team tells you otherwise.

7 - Will I have any dietary restrictions?
After the operation, especially within the first 2 weeks, you may have complaints such as loss of appetite, a sense of bad smells or nausea. After your discharge there is no very strict restriction on food. However, especially within the first 2 weeks, we recommend that you eat foods that do not cause gas and are easy to digest. In particular, we do not recommend legumes (dried beans, chickpeas, etc.) or excessively fatty foods prepared outside the home (lahmacun, fatty kebabs, etc.) during the first 15 days. Apart from this, there is no restriction on carbohydrate-containing and sugary foods, as long as you do not overdo it. Since excessive weight gain in the long term will cause problems, care should be taken in this regard and your weight should be checked at intervals.

8 - When can I travel?
There is no objection to your travelling 1 week after discharge.

9 - Is there any medication I need to take permanently?
Apart from taking vitamins and a stomach protector for a period (about 3 months) to increase your body’s resistance, there is no medication you need to take continuously. However, within the first year, if you need to take any particular medication for other reasons, or if surgery is in question, you must be sure to consult the LIVER DONOR TEAM.

10 - Is the gallbladder removed during the operation? Could this cause me a problem in the future?
In liver transplantation for an adult recipient, the gallbladder is removed in order to expose the bile ducts. However, in donor operations performed for infants or small children, the gallbladder is not removed unless it is really necessary. Removal of the gallbladder will not cause you any problem.

11 - When can I start work?
About 3 months after the operation, you can return to an active life. However, during these first 3 months you must not take on a heavy workload.

12 - Do I need to use an abdominal corset?
To minimize the likelihood of a hernia, we recommend that you use an abdominal corset during the first 3 months.

13 - Will I have check-ups?
If there is no problem after your discharge, your routine check-ups will be carried out at the Organ Transplant Outpatient Clinic in the 1st and 3rd months.

14 - Which tests will be done at my check-ups?
Blood tests are done in the 1st month. An ultrasound is taken in the 3rd month. Apart from this, you can come in for a check-up whenever you wish if you have any complaint.