Organ & Tissue Transplantation Centers


It has been more than a hundred years since the first experiments in organ transplantation. In early studies, transplantation experiments were performed only on animals. The first organ transplantation procedure on humans was performed approximately fifty years ago. Thanks to the great achievements in medicine and healthcare, organ transplantation has finally reached a level that saves human life.

As a reference center for many complex treatments, ACIBADEM Healthcare Group has achieved many firsts in Turkey, which include firsts in organ and tissue transplantation as well. Among the firsts of ACIBADEM there are; the first kidney transplantation performed on the baby with the lowest weight, the first donor nephrectomy of an 84-year-old donor, the first single-port donor nephrectomy, the first donor nephrectomy through the vagina with the NOTES method, the first kidney transplant from an 85-year-old donor with brain death and the first transplant of a liver piece from the mother donor to her 8-year-old child are a few examples of such achievements.

Promising advances take place in organ transplantation every single day. Recipients and donors, as well as scientists and physicians keep striving for healthier and longer lives.

The dysfunctionality of an organ/tissue may lead a slow or sometimes a fast deterioration of the entire body. Although, there are many treatment options for patients with organ failure, transplantation is accepted as the best alternative in terms of the therapeutic benefits, quality of life and cost effectiveness.

Organ/tissue transplantation is the transfer of an organ/tissue from one body or from a donor site to the patient’s own body. The reason of organ/tissue transplant is to replace a damaged or absent organ/tissue. Kidney failure, liver failure, lung or heart diseases, Type I diabetes and some cancer types such as leukemia are conditions that might be treated with organ/tissue transplantation. Organ/tissue transplantation may be either within the same person’s body, which is called an autograft, or from another body, which is called allograft.

There are two types of organ/tissue transplantation regarding donor types: from living donors and from deceased donors (patients in intensive care units with brain death). Since people are born with two kidneys, and one kidney is sufficient to continue our lives and the liver is a regenerative organ, kidneys and liver may be transplanted from a living donor.

The ophthalmology departments of ACIBADEM Hospitals are state-of-the-art eye care facilities with ophthalmologists specialized in the treatment and cure of all eye conditions.Below are examples of procedures carried out at our ophthalmology departments:

Refractive Surgery

  • iLASIK (Femtosecond Laser Technology, Wavefront-guided LASIK)
  • PRK
  • LASEK
  • Phakic Intraocular Lens
  • Multifocal Intraocular Lens
  • Kamra Inlay

Cataract Surgery

  • Phacoemulsification with monofocal and multifocal/trifocal intraocular lenses
  • Femtolaser-Assisted Cataract Surgery
  • Nd:YAG Laser Capsulotomy

Corneal Diseases and Transplants

  • Keratoconus Diagnosis and Treatment
  • Corneal Topography (Pentacam, iDesign)
  • Pachymetry
  • Specular Microscopy
  • Intacs with Femtosecond Laser
  • PTK
  • Corneal transplantation (PK, Femtolaser-assisted PK, DALK, DMEK)

Retinal Diseases & Vitreoretinal Surgery

  • Fundus Fluroscein Angiography
  • Indocyanin Green Angiography
  • Macular OCT
  • Argon Laser Treatment (Diabetic and Hypertensive Retinopathy)
  • Intravitreal Injections
  • Vitreoretinal Surgery

Oculoplastic Surgery

  • Eye Lid Surgery
  • Lacrimal System Surgeries (DCR and endoscopic DCR)
  • Ocular Prosthesis
  • Periocular Botox and Fillers

Glaucoma Diagnosis and Treatment

  • Visual Field Testing
  • OCT-RNFL (Optical Coherence Tomography)
  • HRT-3 (Heidelberg Retinal Tomography)
  • Surgery and Laser Treatments for Glaucoma

Strabismus

  • Strabismus Surgery
  • Botox Treatment for Strabismus
  • Orthoptic Treatment
  • Ambylopia (Lazy Eye) Treatment

Neuro-Ophthalmology

  • Electrophysiological Tests
  • Gene Therapy

ACIBADEM Healthcare Group includes three centers that offer special services to adult and pediatric patients regarding bone marrow transplantation which is used in the treatment of some blood disorders and cancer types. These diseases may be seen at any phase of life and they are accepted as a significant group of diseases because of their lethal consequences.

Bone Marrow Transplantation Centers supported by ACIBADEM infrastructure, harbors all the infrastructure and equipment for transplantation. All services in the center are given according to international standards and in sterile settings. The department for hospitalized patients provides transplantation, and the outpatient clinic provides post transplantation care services.

What are the methods for stem cell transfer?

ALLOGENEIC TRANSPLANTATION

This is the transplantation of stem cells harvested from the patient’s siblings, relatives, or other people who are non-relatives.

AUTOLOGOUS TRANSPLANTATION

This is the transplantation of stem cells taken from the patient for the treatment of some blood disorders.

SYNGENEIC TRANSPLANTATION

This is the transplantation of stem cells taken from one of the monozy­gotic twins to the other.

Transplantation method of the future

α –β T CELL DEPLETED CELL TRANSPLANTATION

A very special method of transplantation performed in only a few centers worldwide is the bone marrow – stem cell transplantation, which reduces the number of dangerous cells (α –β T cells). This transplantation is a candidate for eliminating the problem of finding a donor completely, and it is the transplantation method of the future.

During the application of this method, dangerous cells and NK (natural killer) cells are isolated, while the blood stem cells are given to the patients in mega (very high) doses. The advantages of this method are:

– Less lethal reactions (GVHD)

– Effective combat against cancer

– Shorter duration of hospitalization

As part of this type of transplantation, a 12/12 tissue match is not considered essential, and your mother, father, semi-compatible sibling, or your child can be a donor even if you do not have a full compatibility.

What is a stem cell?

The main cells that generate all tissues and organs in the body are stem cells. These cells, undifferentiated yet; have the ability to divide, renew themselves, and transform into organ and tissues. Blood is the liquid tissue of the body and it is produced in the bone marrow. Hema­topoietic or “blood producing stem cells” are located here. These are produced by the principal cells in the bone marrow and released into the bloodstream when they reach necessary maturity. Their number is constant, however when necessary they can both reproduce on their own or produce new and mature blood cells.

How is stem cell transfer carried out?

A place has to be opened for the new incoming cells in the body of the person who will undergo transplantation. Therefore before the operation the bone marrow of the patient is destroyed by drugs and radiation. On the day when this preparatory phase which takes an average of 7-8 days period ends, bone marrow transplantation is accomplished by transferring new stem cells to the patient.

The stem cells that are transplanted know where they will go, therefore they are programmed for these spots. They select empty places in the bone marrow available for reproduction, lodge there and reproduce like a seed.

Why ACIBADEM in Bone Marrow Transplantation?

  • Haploidentical transplants at ACIBADEM Hospital are performed by alpha-beta T-cell depletion to reduce the lethal complication of Graft versus host disease and hence reduce mortality as a result of this complication.
  • CD19 positive cells are also depleted to avoid post-transplant lethal Epstein Barr Virus (EBV) infection. This also avoids EBV related lethal Lymhoproliferative disease.
  • Mesenchymal stem cell support which helps to reduce Graft versus host disease, aid engraftment and help speedy recovery of immune function.
  • ACIBADEM Hospital utilizes the latest transplant technologies and with the aid of an experienced clinical transplant team provides the patient with the best chance of survival.
  • ACIBADEM Hospital presents economical transplant packages and is highly competitive in comparison with Western Europe and USA.

ACIBADEM Organ Transplant Centers are the focus of attention with its team of experienced specialists, state-of-the-art technology and the successful liver transplants.

The only organ that can regenerate itself

The liver is regarded as the most complicated and metabolically active organ in our body. However, the liver can also continue functioning even when 70% of its tissue has to be removed. When a liver donor donates more than half of his/her liver for transplantation, the remaining part can resume its function without any loss or serious complication. We owe this ability to the liver’s capacity for regeneration, because the liver is the only organ that can regenerate itself after the removal of more than half of its tissue.

When is a liver transplantation needed?

Even when inflammations related to alcohol consumption or fatty liver disease, hepatitis infections, long-term congestions or stones of the bile ducts, certain metabolic diseases, tumors, or congenital enzyme deficiencies are present, patients can continue a normal life for a long time as long as the progress of the disease is slow. But once the liver insufficiency becomes manifest, it may lead to itching, edema in the lungs and ascites in the abdomen, severe hepatitis, bleeding and anemia.

In advanced liver disease, changes in personality and behavior may be observed. Weight loss, reduced amount of urine, and fatigue may progress to a coma.

These symptoms point out that the patient’s liver cannot fulfill the body’s needs. This condition, called “liver failure”, leaves a liver transplant as the only option for the patient.

Successful Results in the Gold Standard “Orthotopic Liver Transplant”

In ACIBADEM Organ Transplant Centres, liver transplantation is performed both from live donors and cadavers. The method applied during these operations is orthotopic liver transplant, a method regarded as the “gold standard” around the world. Through this modern technique, the large vein located behind the liver is preserved using surgical clips before the transplant is performed. For the success of this operation, a surgical team and equipment with a high technical capacity are required. Like every transplant, liver transplants should also be carried out in hospitals and operating rooms equipped with the highest technology. When the transplant is made from a live donor, half of the liver is transplanted to the organ receiver. Thus, the surgical process is technically very demanding. Following the transplant, while live donors can be discharged within 6-7 days, organ receivers have to stay at the hospital for 15-20 days. The transplanted liver then regenerates itself and grows rapidly to a size large enough to meet the needs of the receiver.

International Quality in Infrastructure

The ACIBADEM Organ Transplant Centers give service with their technical infrastructure matching international standards. Organ receivers and donors are treated in operating rooms and intensive care units under completely sterile conditions with laminar flow and state-of-the-art technological equipment. The laboratory procedures are carried out at ACIBADEM Labmed, a laboratory of international standards which is also a member of the ACIBADEM Healthcare group.

our-team

Experienced Team

The Organ Transplant Centers possess all the necessary technology for liver transplantation. Director of this liver transplant center is Prof. Dr. Remzi Emiroğlu, who has broken new ground in kidney and liver transplants in Turkey. Since 1998, Prof. Emiroğlu has performed approximately 700 liver and kidney transplants.

Prof. Emiroğlu and his team are experienced both in auxillary (i.e. without removing the whole liver), and in standard orthotopic liver transplants. The team also has experience in every kind of shunt surgery and Sugiura procedures in patients with bleeding due to liver cirrhosis. Prof. Emiroğlu, who has performed the first transplants to adult and paediatric patients from live donors and cadavers has approximately 100 scientific articles on organ transplantation, 85 of which have been published abroad.

Phase Of Liver Transplantation

Referral and Evaluation: At the time of the application or referral of a patient for liver transplant the transplant coordinators will collect the patient’s physical information, past medical history and results of any previous diagnostic tests and treatments as well as a description of his or her current condition and legal paperwork. A transplant evaluation will be scheduled for the patient, which will include;

Laboratory tests, including blood and urine tests to assess the health of donors and recipients organs, including the liver

Recipient: Hemogramm, Coagulation, Biochemistry, Liver Function tests, Kidney Function Test, Lipid Profile, Tumor Markers, Viral Markers,Metabolic and Vitamin, Endocrinology Donor: Hemogramm, Coagulation, Biochemistry, Liver Function tests, Viral Markers, Metabolic and Vitamin, Endocrinology, Kidney Function, Lipid Profile, Tumor Markers,Viral scanning, Uriner tests

Radiological imaging tests, such as an ultrasound of donors and recipients liver

Recipient: Liver Vascular Doppler, CT& Angio CT, MRI, Breast USG or Mammography (if female) Donor: CT&CT Angio, MRI, MRCP, ECG, Chest X- Ray, Liver Bx, Breast USG or Mammography (if female)

A general health exam, to consult donors and recipients overall health:

Cardiology Consultation Gastroenterology Nephrology Dentistry Infection Diseases and Microbiology

Supplementary consultations and interventions, necessary following all the examinations and imaging.

Recipient over age 40: Gynecology or urology, endoscopy and colonoscopy Donor over age 40: Gynecology or urology, endoscopy and colonoscopy

Psychological evaluation to determine whether donor and recipients fully understand the risks of a liver transplant

Transplant Surgery In ACIBADEM Liver Transplant Center all liver transplants are done in an orthotopic fashion, that is, the native liver is removed and the new liver is placed in the same anatomic location. The transplant operation can be conceptualized as consisting of the hepatectomy (liver removal) phase, the anhepatic (no liver) phase, and the postimplantation phase. The operation is done through an incision in the upper abdomen. The hepatectomy involves division of all ligamentous attachments to the liver, as well as the common bile duct, hepatic artery, hepatic vein and portal vein. The donor’s blood in the liver will be replaced by an ice-cold organ storage solution, until the allograft liver is implanted. Implantation involves connections of the inferior vena cava, portal vein, and hepatic artery. After blood flow is restored to the new liver, the biliary connection is constructed, either to the recipient’s own bile duct or to the small intestine. The surgery usually takes between five and six hours, but may be longer or shorter due to the difficulty of the operation.

Post Transplantation Life after transplant involves continuous follow-up by a physician as well as certain measures to more easily adapt to daily life. The recipient would need follow-up outpatient visits to ensure his or her general health and the functioning of the transplanted organ. These follow-up visits get less frequent over time and the recipient can reach the transplant center via telephone or internet anytime the patient has a concern or question. The donor would get a physical examination prior to discharge from the hospital to ensure his or her general health and the functioning of the remaining organ. First follow-up visit would be in 6 months and then annually. Mindful physical activity, healthy and balanced nutrition, general hygiene and preventive measures for infections are important for organ recipients.

The ACIBADEM Healthcare Group opened its first Organ Transplant Center in October of 2010. Today, it serves with 3 centers located at the International Hospital in Istanbul, then ACIBADEM Bursa Hospital and ACIBADEM University Hospital. The Organ Transplant Centers host teams trained at world-renown institutions with experience of over 2000 kidney, 250 liver and 60 pancreas transplants over the course of their careers. The centers are supported by the best clinical laboratory and intensive care unit of the country and performs kidney and liver transplantation.

ACIBADEM Advantages in Kidney Transplantation

State-of-the-Art Technology and Highest Quality Service

The operating rooms and the intensive care units of the Organ Transplant Centers are equipped with the latest technology infrastructure. The full laparoscopic technique diminishes the need for intensive care for the donor. However, for liver and some kidney recipients full-fledged intensive care units are of critical importance.

The donor protection program (follow-up and care of the donor after the transplantation) is one of the unique services offered by the International Hospital Transplant Center.

The Organ Transplant Centers are fully dedicated to highest of moral and ethical standards in organ donation and transplantation. It adheres to the principles of The Declaration of Istanbul on Organ Trafficking and Transplantation Tourism by the Transplantation Society and the International Society of Nephrology, as well as the Consensus Statement of the Amsterdam Forum adopted by The Transplantation Society on the care of the living kidney donors. The Center also meets the standards of the Turkish Organ and Tissue Transplant Coordination System.

Infrastructure based on international standards

Operation theatres, laboratories and intensive care units are the most important of areas in organ transplantation. The advanced technology and internationally recognized high quality standards made available enable organ transplantation patients and donors to receive utmost medical services and care in the laboratories, intensive care units and operation theatres of ACIBADEM.

Specialists with international experience perform operations using high-tech methods. Such an example is the removal of kidney with a mere 5-cm incision in the groin, performed entirely by laparoscopic surgery. The advanced medical methods practiced enable donors to be discharged within 24-hours after surgery and to be able to start work within a week’s time. Recipient can be discharged from the hospital within approximately one week.

First in ACIBADEM :

– The first single port (from navel) donor nephrectomy of Turkey in 2011.

– The first donor nephrectomy with NOTES method (from vagina) of Turkey in 2011.

– The first single port + NOTES donor nephrectomy (from vagina) of Turkey in 2013.

Full-Laparoscopic Techniques

Full laparoscopic techniques used for surgery enable a minimum length of stay for donors. These techniques are used only at centers with highly experienced and expert staff and they offer many advantages over open surgeries: For example, while open surgeries involve 15-20 cm incisions, laparoscopy enables incisions only 5-cm in length. The operation is made possible by a camera inserted into the abdomen and enabling high visual control. A smaller operation area implies less post-operation pain and surgical wounds carrying less risk. The absence of large surgical scars diminishes cosmetic concerns and lowers risk of herniation, numbness, surgical site infections, and pulmonary embolisms. With the laparoscopic technique, donors are enabled to be mobilized and to start fluid intake the evening of the surgery, to start solid food intake and get discharged the following day, and to start work the next week. The recipient is discharged within approximately a week.

What needs to be known about transplantation?

Medical and Social Requirements for Kidney Transplantation – Patient Hospitalization

Prospective patients who have applied to the ACIBADEM Healthcare Group Transplantation Center with requests of kidney transplantation are required to have undergone a nephrology examination and have the analyses listed below conducted for Chronic Renal Failure diagnosis. If the patient has not yet received this diagnosis in his/her country and/or is in doubt, he/she will be given the necessary preliminary analyses and the nephrology examination at our Center for an evaluation of his/her application. These analyses are not included in the package price for kidney transplantations.

If the patient has already received this diagnosis in his/her country, is certain about her decision, and has applied for transplantation, all analyses and costs are covered in the package price quoted for transplantation.

Preliminary analysis required for diagnosis

Urine Analysis, Full Albumine Calcium Creatinine Creatinine Clearance Phosphor, Inorganic Potassium Protein, Urine (24-hour) Sodium (Na) Aspartate Aminotranspherase Alanine Aminotranspherase Blood Urea Nitrogen (BUN) Blood Count, Automatic Hemogram (Wide Panel) Parathormone (PTH), Intact USG, Urinary System Requirements for becoming a living donor for patients

Requirements for becoming a living donor for patients who will come from abroad and who want to utilize the ACIBADEM Transplantation Center offering kidney and pancreas* transplantation service are the following:

  1. Blood groups of the recipient and donor should be compatible. Blood group compatibility requirements are as follows:

RECIPIENT DONOR A A or 0 B B or 0 AB A, B, AB, 0 (all blood groups may donate) 0 0 (only group 0 may donate) The RH factor does not matter. Both (-) and (+) may donate to each other.

Patient without blood group compatibility may refer to the cross transplantation list. However, this service is available only to Turkish citizens.

The kidney donor candidate must be a relative of the patient or his/her spouse up to the fourth degree. Accordingly, First Degree Relatives: Mother-father-child

Second Degree Relatives: Sibling, grandfather, grandmother, grandchild

Third Degree Relatives: Paternal/maternal uncle, paternal/maternal aunt, cousin (child of sibling)

Fourth Degree Relatives: Children of third degree relatives.

Relatives of the spouse of the person are ranked in the same way.

The candidate kidney donor must be 18 years of age or older, and mentally stable. If the candidate donor has known health problem or a weight problem, he/she must contact the Center by phone prior to his/her visit Who Can Not Be Living Kidney Donors?

check-up2

Children under 18 years of age with diabetes mellitus, and hypertension patients ( medically proven ) Those with recurrent kidney stones Those with kidney diseases Cancer patients (excluding skin and some CNS tumors ) Immediate family members such as brothers, sisters, parents or children are the first choice among living donors to increases the chances of blood and tissue compatibility. Children under 18 years of age cannot donate organs legally in Turkey, even if to family members. Organ donation from a living person is a voluntary gift and cannot be coerced or paid for.

International patients can receive transplantation from living donors. In order to be considered for living donation transplantation, individuals should apply to the legal authorities in their countries and provide official documentation that the intended donor and recipient are related to the 4th degree or closer (i.e., parents and children are first-degree relatives; siblings, grand-children and grand-parents are second-degree relatives; uncles, aunts and cousins are third-degree relatives; and children of third-degree relatives are considered fourth-degree relatives. These relations can be established either through blood or marriage). The aforementioned documents should be submitted to the Organ Coordinator for evaluation and submittal to the Local Ethics Committee, should the need arise. Further information about the process can be obtained from our Organ Coordinators.

Phase1 Referral and Evaluation: At the time of the referral of a patient for kidney transplant, the transplant coordinators will collect the patient’s physical information, past medical history and results of any previous diagnostic tests and treatments as well as a description of his or her current condition and legal paperwork. A transplant evaluation will be scheduled for the patient, which will include;

Laboratory tests, including blood and urine tests to assess the health of donors and recipients organs

Recipient: Hemogramm, Biochemistry, Liver Function tests, Kidney Function Test, Lipid Profile, Tumor Markers, Viral Markers, Metabolic and Vitamin, Endocrinology

Donor: Hemogramm, Coagulation, Biochemistry, Liver Function tests, Viral Markers, Metabolic and Vitamin, Endocrinology, Kidney Function, Lipid Profile, Tumor Markers,Viral scanning, Uriner tests

Radiological imaging & Nucleer Medicine tests,

Recipient: Abdomen USG, Chest X-Ray, Breast USG(if female)

Donor: CT&CT Angio, ECG, Chest X- Ray, Breast USG (if female), DTPA

A general health exam, to consult donors and recipients overall health:

Cardiology Consultation Nephorology Gastroentrology Dentistry Infection Diseases and Microbiology

Supplementary consultations and interventions, necessary following all the examinations and imaging.

Recipient over age 40: Gynecology or urology, endoscopy and colonoscopy

Donor over age 40: Gynecology or urology, endoscopy and colonoscopy

Psychological evaluation to determine whether donor and recipients fully understand the risks of a liver transplant

Meetings with social workers who assess the recipients support network to determine whether he/she has friends or family to help care for him/her after transplant

Phase 2 Transplant Surgery

In ACIBADEM Kidney Transplant Center the removal of kidney with a mere 5-cm incision in the groin, performed entirely by laparoscopic surgery. The advanced medical methods practiced enable donors to be discharged within 24-hours after surgery and to be able to start work within a week’s time. Recipient can be discharged from the hospital within approximately one week.

Phase3 Post Transplantation Life after transplant involves continuous follow-up by a physician as well as certain measures to more easily adapt to daily life. The recipient would need follow-up outpatient visits to ensure his or her general health and the functioning of the transplanted organ. These follow-up visits get less frequent over time and the recipient can reach the transplant center via telephone or internet anytime the patient has a concern or question. The donor would get a physical examination prior to discharge from the hospital to ensure his or her general health and the functioning of the remaining organ.