Interview with transplant surgeon Ayhan Dinchkan (Liv Istinye Clinic, Turkey)

Turkey is one of the leading countries in the world in terms of the number of organ transplants performed. World famous doctors work here. And one of them is Ayhan Dinchkan, a transplant surgeon at the Liv Istinye clinic. In an interview, the doctor answered the most pressing questions regarding organ transplantation for patients.

How many organ transplants have you performed?

During my work, I have transplanted more than 6,000 organs, and I can no longer say exactly how many there were. I have performed over 5,000 kidney transplants, about 1,000 liver transplants, and about 100 pancreas transplants. After each operation, I am literally born again with my patient.

How old were your oldest and youngest patients?

The oldest cadaveric liver donor was a patient who died at the age of 94. Prior to this, we transplanted a kidney to an 87-year-old patient. I have many patients over 70 who have had both liver and kidney transplants successfully. Our youngest donor was a 3-month-old baby. The youngest liver transplant recipient was a child aged 3.5 months, who received a kidney transplant – a child aged 5.5 months. More than 15% of our liver and kidney transplant patients are children.

What problems do doctors in Turkey face in organ transplantation?

The most basic negative points, of course, are the lack of information and indifference. Due to social pressure and distrust of the donation system, there are very few cadaveric donors. Nevertheless, the Turkish Ministry of Health is doing a lot of educational work in this regard. Therefore, we hope that the situation will change for the better soon.

Why are people reluctant to donate organs?

There are some misconceptions in this area. For example, some people think that by donating an organ, they will remain a demi-human. There are still some concerns that the operation to remove a donor organ is associated with a high risk. However, we know that people who donate their organs live much longer because they are under constant medical supervision.

There is also a myth that donor organs do not last long. This is also not true. Today, medicine has come a long way. If we talk about kidney transplantation combined with innovative drug therapy, 75% of patients still do not need a second transplant 10 years after transplantation. With a liver transplant, this percentage is even higher, at 80–85%.

Is a transplant possible if the blood type is incompatible?

The search for a suitable donor is one of the most urgent problems of modern transplantology. In Turkey, there is an opportunity to solve this problem through cross-transplantation. Its essence lies in the fact that two or more couples exchange donors according to the principle of immune compatibility. This approach can significantly reduce the waiting time.

What is Turkey’s place in the world in organ transplantation?

We are among the top three in the world in terms of the number of transplants performed. However, 80% of transplants in Turkey are from living donors, and only 20% are from cadaveric ones. We hope that these numbers will change in the near future.

What are the conditions for an organ transplant?

For transplantation, the patient, first of all, must have an end-stage organ failure. For example: chronic kidney disease, heart failure, chronic liver disease, etc. Very rarely, other health problems, such as severe malnutrition or metabolic diseases, are considered as reasons for transplantation.

After determining the feasibility of transplantation, during a comprehensive examination, the general health of the patient is checked. Organ transplants are performed at transplantation centers licensed by the Turkish Ministry of Health. According to the laws of our country, a living donor must be a relative up to the fourth stage of kinship. In the absence of a living donor, the patient’s details are entered into the list of the national organ waiting system. The length of the wait depends on the type of organ that the patient needs, as well as on the state of his health. After that, it is necessary to wait until a suitable organ is found. Phones of the patient and his relatives must be available 24 hours a day, 7 days a week.

Transplantation from a living or cadaveric donor: which is better?

Of course, cadaveric donors should be preferred as a source of organs for transplantation. However, organ transplants from living donors save lives. Waiting lists are growing every day and not all patients are waiting for their turn.

In Turkey, transplantation from unrelated donors is possible only if approved by the Ethics Committee. In addition, only those patients who need a new liver or kidney can receive an organ from a living donor. Recipients who need a heart or lungs can only rely on cadaveric donors.

What should be considered during the recovery period after transplantation?

Organ transplantation is primarily a surgical operation, and it must be successful. First of all, it is necessary to take certain drugs strictly in accordance with the doctor’s recommendations. Patients should also visit the doctor every 3 months after surgery. If there are no complications, the interval between examinations can be reduced.

In general, patients after organ transplantation experience a significant improvement in the quality of life. They can study, work, relax, build family relationships, have children, travel, play sports and live a fulfilling life. Our doctors inform people in detail about how to behave after the operation. They also provide telephones that can be called in case of an emergency.

What are the risks of organ transplantation, in what cases is it dangerous?

Before transplantation, the patient undergoes a comprehensive diagnostic examination. The decision to perform the operation is made by a council consisting of medical specialists of various profiles. In the presence of cancerous tumors, an active infection, a violation of the general state of health, contraindications to surgical intervention, transplantation is definitely not performed.

Is there a danger to the donor during an organ transplant?

Living donors are the only group of healthy people who get on the operating table. Before transplantation, a comprehensive diagnostic assessment of their condition is carried out. For this, laboratory and instrumental studies are used. If necessary, an organ biopsy can be performed. It often happens that during the examination, donors are diagnosed with diseases that are an obstacle to transplantation, and the operation is not performed. The operational risk for the donor is also present, but it is not much higher than with standard surgery.

What are the benefits of organ transplantation?

Today, transplantation is a treatment awaited with hope by thousands of patients. For many of them, organ transplantation remains the only chance for survival. Life expectancy after a kidney transplant more than doubles. And this result cannot be achieved using other approaches. The treatment of kidney failure alone accounts for more than 5% of total health care spending. And after transplantation, patients can lead a full life and work, contributing to the country’s economy.