A patient diagnosed with end-stage renal disease by a nephrologist should be directed to the nearest organ transplant center without delay. Here, the nephrologist evaluating the patient first evaluates the patient in terms of living donor kidney transplantation.
Relatives of patients who have not yet entered dialysis or who are currently undergoing dialysis treatment whose blood type matches and who do not have blood pressure, diabetes or kidney disease are determined. The nephrologist directs the patient and possible donor candidates to the organ transplant coordinator. In the center, blood group tests are repeated first and after the LCM study, a psychiatric consultation is requested for the patient and his relatives in terms of suitability for organ transplantation. Patients and donors who have all these tests without problems are examined by nephrology and surgery teams. In our center, tissue compatibility is not considered as an indispensable condition for organ transplantation from living beings.
The examinations and examinations made are evaluated in the council and the final decision is made by the established council.
BENEFITS OF KIDNEY TRANSPLANTATION:
Undoubtedly, kidney transplantation is the best treatment method for end-stage kidney patients. Dialysis methods (hemodialysis or peritoneal dialysis) can do 5% of the work of two kidneys of a healthy person under the best conditions. Successfully transplanted kidney provides 10 times of this (50% of the work done by both kidneys of a healthy person).
Most transplant patients feel much more energetic and better than they are on dialysis. While many of them are able to do their job that they could not do before, their chances of finding a job are higher than dialysis patients. Most of them have a significant improvement in their sexual life compared to the dialysis period, female patients can conceive more easily and give birth to healthy children.
WHAT IS PRE-EMPTIVE KIDNEY TRANSPLANTATION? (TRANSFER WITHOUT DIALYSIS)
Renal filtration (Glomerular filtration rate) is a form of transplantation applied to patients who have decreased below 20 ml / min and have not yet received a dialysis treatment.
Among the forms of transplantation in my application, the results are the most successful. In this respect, it is very important that patients who have been diagnosed with chronic kidney failure and who are on the way to dialysis (especially those with a rapid progression to end-stage renal failure, such as diabetics), are sent to transplant
centers before end-stage renal failure develops and the treatment method (dialysis or transplant) is determined in advance.
In our center, pre-emptive kidney transplantation is applied only to candidates who are living donors, and these patients do not receive kidney transplantation from cadavers.
In patients with living donors, if possible, transplantation should be attempted as soon as possible before undergoing dialysis.
BLOOD GROUP COMPLIANCE:
There are four basic blood types: A, B, AB, and O (zero).
- Group O
- Group A
- Group B
- AB Group
- can Only give O Group
- can Only give A Group
- can give Group B or Group O
- can give any group (O, A, B or AB)
The importance of blood group in terms of transplantation depends on the presence of these antigens on the surface of not only red blood cells but also all known body cells. Blood group antigens act like identification cards for cells. Thanks to them, the immune system in our body can distinguish between what is foreign to the body and what belongs to the body. The main purpose here is to introduce the donor’s blood group antigen to the recipient as if it were their own blood group. With filters used for this purpose (similar to dialysis filters), antibodies that exist in the body of the recipient and perceive the donor’s kidney as an “enemy” are destroyed. Transplantation may be possible after repeating this process several times, just like removing toxic substances from dialysis.
Transplantation with incompatible blood type was applied successfully to 8 patients by our team.
The Rh factor (i.e., negative or positive) of the blood type is not important. For example, A (-) can deliver a human kidney to both A (-) and A (+) recipients. Similarly, both B (-) and B (+) patients are called for the organ from cadaver with B (+) blood group.
When comparing transplants from twin siblings (all tissues are the same) and transplants made with only blood group compatibility without any tissue compatibility, it is seen that the rate of survival of the transplanted kidney in the 5th year is negligible at a rate of 7% compared to twins. When transplants with no tissue compatibility are compared with transplants with 5 out of 6 tissue compatibility, it is seen that the survival rate of the transplanted kidney in the 5th year is similar (80%). Considering that half of the hemodialysis patients die in the 5th year in our country, the chance of “transplantation without seeking tissue compatibility” must be given to the patients in order to keep them alive.
Tissue type is the characteristic set of antigens that pass to humans from their parents and are found on the surface of almost all cells. Just like blood type, it does not change throughout life and is our password as an individual. Everyone has a tissue type and 6 different antigens that make up this tissue type.
There are three basic tissue type characteristics (antigens): A, B and DR. Each individual shows a total of 6 characteristics, 2A, 2B and 2DR, taken from the mother and one from the father.
What percentage of tissues should be for a successful transplant?
Tissue group compatibility has lost its importance in living-to-kidney transplantation Six out of six (fully compatible) compatible transplants have been shown to be more successful than others (3 out of 6, 4 out of 6) (especially transplants from cadavers). However, this does not mean that kidneys that are compatible with blood group and tissue group will not beat. The fact that even kidney transplants from twin siblings can be removed after a while suggests that there are other important indicators other than blood type and tissue type that can cause organ rejection on cell surfaces.
Which one is more important? Blood type compatibility or tissue type compatibility?
Blood group compatibility is much more important than tissue-type compatibility in terms of the success of the transplant.
Lymphocyte Cross Match (LCM- Cross test): In this test, the blood of donor and recipient candidate is mixed. With this test, the presence of antibodies in the recipient’s blood that can react with the donor’s kidney (under normal conditions, these antibodies protect the human against infections) are investigated.
In the presence of high amounts of antibodies, the recipient’s blood will react with the donor’s blood and the test will be positive. In this case, the kidney will be lost within hours-days if the transplant is performed.
This test is the first test required after blood and tissue compatibility in transplants from living or cadavers. The risk of a positive test is higher, especially in patients who have had a kidney transplant and have had blood transfusions in the past. For this reason, blood should never be given to dialysis patients unless it is absolutely necessary.
Does the positive cross test (LCM) mean that there will be no transplant?
If this test is positive, it does not mean that everything is over and the patient will not be able to have a transplant again.
With the use of some drugs, it is possible to turn LCM positive cases into negative and make them suitable for transplantation. In our center, we are able to turn the LCM positivity of our patients into negative with a success rate of 85% by gradually increasing the drug with the active ingredient “simvastatin”. This practice has had two important results:
Another important issue is to know that not all LCM positivity prevents transplant. The IgG type of antibody that causes the test to be positive indicates that the transplant is not possible for that period, while the IgM structure indicates that the transplant can be performed easily. In other words, kidney transplantation can be performed easily in IgM-structured LCM positivity.
WHICH TYPE OF KIDNEY TRANSPLANTATION?
There are two types of kidney transplants:
- With a cadaver donor – NOT MADE FOR FOREIGN PATIENTS
- With a live donor – GIVEN TO FOREIGN PATIENTS
KIDNEY TRANSPLANT RULES
FOR LIVE TRANSMITTER (RELATIVE)
- A copy of the notarized identity card (passport) of the recipient and the donor.
- Population register sample taken from the civil registry office showing the kinship between recipient and donor.
- If the donor is married, a letter of consent from the notary public that he is aware of his wife’s kidney donation.
All documents must be translated into Turkish, notarized and apostilled.
FOR LIVE TRANSMISSION (NON-RELATIVE – ETHICS COMMITTEE)
The “National Organ and Tissue Transplant Coordination System” directive entered into force by the Ministry of Health with the approval of the authority dated 28/05/2008 and numbered 37682 in order to facilitate the control of organ and tissue transplants from living beings. Accordingly, organ and tissue transplants from living beings can be performed from the recipient’s fourth degree (including fourth degree) blood and beech relatives. Regarding the fourth-degree kinship; In the 17th article of the Turkish Civil Code, it is stated that the degree of blood kinship is determined by the number of births connecting relatives. According to this; According to the degree of kinship of the person in blood kinship;1st degree relatives: mother, father, child
2nd degree relatives: siblings, grandparents, grandchildren
3rd degree relatives: uncle, aunt, uncle, aunt, nephew
4th degree relatives: children of 3rd degree relatives
It is another feature that must have consent from the spouses.
In the case of kinship by marriage, the person’s relatives by the spouse are graded in the same way.
The status of organ and tissue donor candidates outside of this scope are evaluated by the Ethics Committees established with the approval of the Ministry of Health dated 5/03/2010 and numbered 27512, and the results are reported to the center where the application is approved by the ethics committee. It is accepted that all patients and their relatives entering the ethics committee have read and understood the above explanations.
REQUIRED DOCUMENTS FOR ETHICS COMMITTEE APPLICATION
1- Photocopies of the notarized identity card of the recipient and donor
2- A report of consent for the donor (It can be obtained from the Department of Psychiatry of a University or Training and Research Hospital and at least one Specialist Doctor’s stamp is required.)
Example: The person named ……………. is in our hospital ……………. date and ……….. With the ….. protocol, no apparent psychopathology was detected in the psychiatric examination and it was concluded that we are different and able to be a donor for kidney transplantation. ”
3- At least two witnessed approval (consent) document obtained from the donor. (It will be arranged at our hospital)
4- Consent document (to be arranged at our hospital)
5- Health board report for the recipient and donor. (It will be arranged at our hospital)
6- The petition explaining the origin of the recipient and donor’s proximity should be attached to the petition if there is a document (military discharge certificate, graduation certificate, etc.).
7- Income levels of the donor and the recipient, a certificate of no debt. (For the donor, the payroll obtained from the place of work and the document that there is no attachment on the salary)
8- Residence certificates of the recipient and donor received from the headman
9- The document prepared by the donor in the presence of a notary, stating that he agrees to give the said tissue and organ with his own will without waiting for any response (2 witnesses).
10- If the donor candidate is married, a photocopy of the notarized identity card of his spouse, a copy of the population register documenting his marriage, the consent obtained from the notary public stating that the donor candidate’s spouse has knowledge and approval for organ transplantation
11- Criminal record from the recipient and donor prosecutor’s office.
All documents must be translated into Turkish, notarized and apostilled.