Kidney Transplantation

The kidneys are located just below the rib cage on both sides of the spine. The two organs are bean-shaped and each is the size of a fist. The main function of the kidneys is to filter waste, minerals and fluids in the blood by producing urine, and to filter and expel some harmful and waste substances through urine.

If the kidneys lose their filtering ability, harmful fluids and waste substances accumulate in the body. As a result, high blood pressure and end-stage renal failure may occur. End-stage renal failure is a condition that occurs when the kidneys lose approximately 90% of their normal functions and necessitates a kidney transplant.

What is Kidney Transplant?

Kidney transplantation is the process of replacing a person’s diseased or damaged kidney with a kidney taken from a healthy donor. Kidney transplantation is a treatment method applied to people with kidney failure.

Kidney transplantation can be performed by replacing the insufficient kidney with a kidney taken from a living or cadaver. In this way, the person’s kidney functions can be continued. The only known treatment for chronic kidney failure is kidney transplantation, which is also the most frequently performed organ transplant. Kidney transplantation can also be performed in cases of emergencies called acute kidney failure. Thanks to kidney transplantation, the patient regains their health with a single surgery.

Under normal conditions, kidney transplant surgery takes 3 to 4 hours. Considering the health of living kidney donors and their comfort after surgery, the closed method of removing the kidney, namely the laparoscopic method, is often preferred. The closed method surgery is performed without making a large incision in the patient’s body. 3 holes of 0.5 to 1 cm are opened in the patient’s abdomen. At the end of the surgery, the kidney is removed through a 5 to 6 cm incision made in the groin area.

Patients experience much less pain after surgeries performed with the closed method compared to open surgery. The hospital stay is shorter. Thus, patients can return to work more quickly. In the open method, patients may experience unwanted side effects such as numbness, hernia and wound infection after the surgery. In the closed technique, the risk of such side effects is almost non-existent.

In Which Diseases Is Kidney Transplantation Applied?

Kidney transplantation is applied in cases of end-stage renal failure. Diseases such as diabetes, chronic uncontrolled hypertension, inflammation of the small filters in the kidneys (chronic glomerulonephritis) and eventually permanent loss of function and polycystic kidney disease can lead to advanced-stage renal failure and reach stages requiring kidney transplantation. Treatment options for end-stage renal failure include dialysis and kidney transplantation.

Kidney transplantation is performed on a patient with end-stage renal failure from a living or cadaver. The disease, which progresses without any symptoms, begins to show symptoms when the filtering function of the kidneys, which should be between 85 and 100, drops below 30. The most important symptoms are swelling under the eyelids, mild edema in the hands and feet, weakness and excessive foaming while urinating when the patient wakes up in the morning.

The reason for foamy urine is the presence of a significant amount of protein in the person’s urine. Normally, there can be less than 150 mg of protein in the urine per day. Excessive protein in the urine is an abnormal condition and is known as proteinuria or microalbuminuria. Foaming in the urine is a sign that kidney disease has started or even progressed.

If the necessary precautions are not taken, the rapidly progressing disease can cause the kidney, which can function properly for 10 to 20 years, to deteriorate within 2-3 years. When the filtering function rate drops below 15, it becomes difficult for chronic kidney failure patients to hold on to life without any supportive treatment.

Kidney transplantation is generally recommended to increase the quality of life of patients who have no other treatment option other than dialysis or transplantation and to provide permanent recovery in a short time. Acute renal failure is also a loss of function in the kidneys’ functions that occurs in a very short time and can be reversible in some cases. In irreversible loss of function, it is of critical importance to plan transplantation without delay.

Who Cannot Donate a Kidney? Who Cannot Be a Kidney Donor?

Candidates who will be donors for kidney transplantation should have good general health and psychology. In this way, they can continue their lives after the operation as they did before the operation. The answer to the question of who cannot donate a kidney is listed below:

People under the age of 18
Those with hypertension and those using hypertension medication
Those with diabetes, proteinuria, microscopic hematuria
Those who have recurring kidney stones
Low GFR (glomerular filtration rate)
Those with urological abnormalities in the kidney
Those with weight problems
Those with a history of thrombosis or thromboembolism
Those with chronic lung disease or a recent cancer diagnosis
Those with psychiatric disorders
Those with a family history of hypertension and kidney disease cannot be donor candidates for kidney transplantation.

So who can donate a kidney? Any individual who is 18 years of age or older can be a donor if they do not have any of the conditions or criteria listed above. Although the upper limit for being a donor is 65 years of age, it may be possible to increase this limit by evaluating the person’s general health and kidney functions.

The donor candidate undergoes detailed clinical examinations and tests. If it is determined that his/her health condition is suitable for being a donor for kidney transplantation, he/she can donate organs. The explanation in the 7th clause of the National Organ and Tissue Transplantation Coordination System directive was put into effect with the approval dated June 28, 2004 and numbered 4690, and according to this explanation, the donor candidate covers up to the fourth degree relative of the recipient candidate, and fourth degree relatives are also included. For other cases, the ethical committee at the relevant tissue and organ transplantation center evaluates the situation and organ transplantation is performed if deemed appropriate.

Regarding the fourth degree of kinship, the article in Article 17 of the Turkish Civil Code is as follows: “The degree of blood kinship is determined by the number of births that connect relatives.” In this case, we can list the degrees of kinship as follows:

Mother, father and child are first degree relatives
Sibling, grandfather, grandmother, grandchild are second degree relatives
Uncle, aunt, maternal uncle, aunt, nephew (child of a sibling) are third degree relatives
Children of the third degree persons listed above are fourth degree relatives

Although the idea that the person who donates his/her kidneys may experience kidney failure is widespread in society, such a situation is not the case. The most important criterion for a kidney transplant from a living donor is that the person does not have any health problems. In this way, the person who donates his/her kidney can continue his/her life where he/she left off after the operation.