Liver Transplantation
Liver Transplantation

23 feb. 2017, 09:34:32

Ankara, Turcia


Aiming to provide medical services at international standards, Ankara Güven Hospital, established in 1974, presents a harmony of requirements of modern medicine and years of experience. High quality services that we provide in all aspects increase number of our patients and demands, while the responsibility that we carry for our patient rises. Our story, which began as a small hospital in 1974, has reached a general hospital concept with a capacity of 251 beds, 12 operating theaters and personnel of specialists, practitioners, nurses and allied healthcare personnel in 40.000 meter square area. The pride of achievements motivates us to go further on and raise what we aim for the future. We carry on our path as we always keep in mind that our privilege is the TRUST that our patients feel...


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Why should I trust Güven Hospital?

Aiming to provide medical services at international standards, Ankara Güven Hospital, established in 1974, presents a harmony of requirements of modern medicine and years of experience. High quality services that we provide in all aspects increase number of our patients and demands, while the responsibility that we carry for our patient rises.

Our story, which began as a small hospital in 1974, has reached a general hospital concept with a capacity of 251 beds, 12 operating theaters and personnel of specialists, practitioners, nurses and allied healthcare personnel in 40.000 meter square area. The pride of achievements motivates us to go further on and raise what we aim for the future. We carry on our path as we always keep in mind that our privilege is the TRUST that our patients feel...

Acreditation

Güven hospital has been accredited three times by JCI (Joint Commission International), first on 2008, next on 2011 and then on 2014, which aims to increase patient safety and service quality, to create a safe environment for the patients and minimize the risks for patient and healthcare personnel by determining, implementing and maintaining terms.

Accreditation of JCI is accepted as an international quality evaluation and management organization. Accreditation of JCI aims to provide safety and quality culture in healthcare facilities and to continuously improve healthcare services and results.


Medical Experts

Ankara
Chirurgie generala and 3 more

Liver Transplantation

  • How many hours does the surgery lasts (on average):
    The surgery normaly lasts 12-15 hours.

  • How many days does the patient stay in Intensive Care Unit:
    TWO DAYS

  • Lenght of hospital stay:
    BETWEEN 10-15 DAYS

  • How many times and for how long does the patient receive post-operative controls?
    After surgery ,The patient usually is controlled 2 times within a week. That is included the package price.
  • Does the package price covers donor's hospitilization and operation?
    Yes it does.

SOME INFORMATION FROM GUVEN HOSPITAL'S INFORMED CONSENT FORM FOR LIVER TRANSPLANTATION

II- INFORMATION RELATED TO LIVER TRANSPLANTATION:

Recipient Assessment Process

To evaluate your eligibility for liver transplant, a number of laboratory tests, radiographic studies, endoscopic procedures are performed and various specialties are consulted. Along this process, you will meet members of our multidisciplinary liver transplant team. These include;

The Organ Transplantation Coordinator will provide information about your inclusion in the cadaveric organ waiting list provided that the outcome of the evaluation process indicates that you are an eligible candidate.

The Gastroenterologist is involved in the management and treatment of your condition and possible complications and collaborates with other members of the liver transplant team for the evaluation of your eligibility for the transplant procedure.

The Transplant Surgeon will have a discussion on your eligibility for liver transplant procedure based on information obtained from the evaluation process. Additional information provided by the surgeon includes the importance of the transplantation procedure, different types of liver grafts, surgical risks, and potential post-transplant complications.

The Anesthesiologist makes an assessment with regard to anesthesia-related risks and provides information about the planned type of anesthesia.

The Specialized Unit Nurse has expertise in the care and management of transplant patients and will be in charge of and oversee all nursing care provided to you during your hospitalization.

The Dietician assesses your nutritional status and provides education on nutrition-related issues.

Experts from different departments are involved to provide consultation on the condition of your organ systems [psychiatrist, infectious diseases specialist, nephrologist, pulmonologist, cardiologist, hematologist, etc.] as part of the overall assessment of your eligibility for the planned procedure.

You may have to undergo a number of different tests as part of the assessment of your eligibility for liver transplant procedure. The results of the following tests may require additional tests to be performed.

  • Blood tests help us to understand the stage and/or underlying cause of your liver disease. Other tests, e.g. your blood group, are carried out in order to understand the condition of your immune system or the presence of certain viruses including HIV. Additional blood tests may be needed to understand the functional status of other organs.
  • Chest X-ray is used to identify a problem in your lungs. A urine sample is sent to analysis to evaluate the condition of your urinary tract.
  • ECG and echocardiogram and/or exercise test indicate the functional capacity of your heart, heart rate, and motions of the cardiac valves. These tests help your cardiologist to ensure that your heart is capable to tolerate a major surgical procedure like liver transplantation.
  • Computerized Tomography (CT) or Magnetic Resonance Imaging (MRI) show the condition of your liver disease, the presence of a mass lesion (such as a tumor), and the liver vasculature.
  • A biopsy from the liver may or may not be required. During the biopsy procedure, a small needle is used to collect a small specimen from your liver. This specimen is studied to understand the cause and severity of your liver disease.
  • An ultrasound examination of your liver and abdominal region shows us the condition of your abdominal organs with regard to their size, shape, and vascular structures, and presence of additional problems.
  • Lung function tests are particularly important for smokers or patients with a history of lung disease. Lung function test involves blowing into a tube to measure the capacity of your lungs.
  • Advanced tests, such as endoscopic procedures (gastroscopy, colonoscopy, etc.), thorax CT, mammogram, PET, or bone scintigram may be used to screen for potential malignancies or evaluate the severity of the liver disease.
  • When the evaluation process is complete, the multidisciplinary team (Organ Transplant Board) meets to review the outcome and your eligibility based on the “Liver Transplant Recipient Selection Criteria” of the Ankara Güven Hospital Liver Transplantation Program. In summary, the recipient selection criteria include the following conditions:
    • Severely impaired quality of life (fatigue, weakness, itching),
    • Portal hypertension (bleeding from the throat or rectum due to increased blood pressure in the abdominal vessels, accumulation of intraabdominal fluid that may become infected, confusion),
    • Impaired liver functions (delayed clotting of blood and decreased blood protein levels),
    • Jaundice (yellow discoloration of the skin and sclera as a result of elevated blood bilirubin levels),
    • Impaired kidney and lung functions secondary to the liver disease,
    • Muscle loss and bone disease,
    • Recurrent infection of the bile ducts,
    • Certain types of liver cancer,
    • Presence of overt and refractory heart and lung disease,
    • Abstinence from alcohol and drugs for at least 6 months, if applicable,
    • Absence of extrahepatic cancer foci except the primary liver cancer (e.g. hepatocellular cancer) or certain skin cancers,
    • Absence of systemic infections,
    • Adequate social support for the post-transplant period.

The Surgical Procedure

Liver transplantation is a life-saving procedure for patients with end-stage liver failure. The success of this procedure not only depends on the surgery, but also your compliance with the recommended treatment after the procedure. Please, beware that liver transplantation is not a minor procedure. As with any major surgery, it involves potential risks and complications including death. There is no way your doctor can predict how your body will react to liver transplant. Neither is it possible to know how your underlying liver disease will affect the newly implanted liver. In summary, transplant surgery is both complex and involves high risks. There are many suture lines involving small (2-3 mm) and large (1-2 cm) blood vessels, bile duct openings, and sometimes, the guts. There may be a number of problems involving the suture lines including healing problems, leaks, bleeding, or obstructions. In spite of these potential complications, the survival rate of transplant recipients is between 85 to 90% at first year. In other words, the risk of death in the first year post-transplant is between 10 to 15%. The outcome is largely dependent on the general condition of the patient prior to the transplant procedure. Patients in poor general condition have worse outcomes.

Following the cadaveric organ allocation principles, the Turkish MoH assigns the donated liver to the patient with a matching blood group, who has the most severe condition. Inclusion in the waiting list does not guarantee that a suitable organ will be found and transplanted to you.

Due to the poor rate of cadaveric organ transplantation in Turkey, many patients lose their lives while waiting for a suitable organ. Therefore, part of the liver of a living donor may be used as an alternative source for transplantation. Any relative by blood or by law up to forth degree legally qualifies as a living donor. Other potential donors who don’t meet this criterion have to be approved by the Ethics Committee. In this type of transplantation, the living donors are subjected to rigorous preparatory work to determine compatibility with your tissue type.

Compared to cadaveric donors, transplantation from a living donors has both advantages as well as disadvantages.

  • In terms of the amount of transplanted liver tissue, cadaveric liver transplantation appears to be superior. In summary, the liver as a whole is transplanted from a cadaver whereas only part/half of the organ can be transplanted from a living person.
  • In terms of the tissue quality, however, a graft harvested from a living donor is favorable.
  • Brain dead donors are individuals with partially impaired organ functions and only scarce information about their medical history, who may have stayed at the intensive care unit, whereas living donors are individuals whose medical history is well-known and whose tissue compatibility has been verified using state-of-the-art tests.
  • The liver of a cadaver is harvested under emergency conditions and most of the surgeries are performed at nighttime. Harvesting of an organ from a living donor is scheduled ahead of time and is performed under well-controlled conditions.
  • Cadaveric organs are stored in cold conditions for much longer than their living counterparts. Prolonged cold storage is associated with a poorer survival of the transplanted organ. The average cold exposure time is 8 to 10 hours for cadaveric grafts versus only a couple of hours for organ grafts harvested from living donors. Especially old or fatty liver grafts are more susceptible to cold and prolonged cold exposure may interfere with organ function post-transplant.
  • The vessel and bile duct ends that are anastomosed in living donor transplantations are much smaller than cadaveric transplantations. This explains why the rate of post-transplant bile leaks and risk of arterial obstruction is higher in transplantations from living donors.
  • The most important disadvantage of transplantation from a living donor is that it requires a healthy donors. This means that an otherwise healthy person has to take surgical risks.

Transplantation procedure

As soon as an organ from a brain dead donor is found, you will be contacted over the telephone. You are required to report to the hospital as soon as possible for the preliminary preparations. You have the right to refuse the offered organ at any time.

The above process does not apply in case of liver transplant from a living donor.

During the transplant surgery, you will be put to sleep under general anesthesia. Owing to the medications administered, you won’t feel any pain, your body won’t be able to move, and you will be connected to a machine that helps you breathing. The transplant surgeon will make an incision in your abdomen and use this penetration to remove your liver and gallbladder and replace it with the donated liver graft (without the gallbladder).

Although rare, venovenous bypass machine may be needed during the surgery. Plastic tubes are inserted to veins in the inguinal and neck region. The transplant surgeon decides whether the bypass machine is required based on the needs that emerge during the procedure. Plastic drains are placed in your abdomen to drain out any accumulated fluid from your body and to speed up the healing process. Long stockings are worn that enhance the blood circulation and help to prevent blood clots. The surgery itself usually lasts between 6 to 12 hours.

Postoperative Care

After the surgery, you will be admitted to the intensive care unit for close monitoring. At this unit, you will again be connected to the artificial ventilator and you will be weaned off this machine depending on your lung capacity and wakefulness. You may feel pain when you start to wake up. Your will be given appropriate amounts of pain killers to control your pain. You will feel the presence of the various tubes and drains that are connected to your body.

Pain usually decreases significantly over the 2 to 3 weeks after the surgery. When your condition improves, you will be discharged from the intensive care unit to the transplant unit. The average length of stay in the intensive care unit is 1 to 2 days. However, depending on the severity of your condition before the transplant procedure, the surgery itself and the functionality of the transplanted organ, your stay in the intensive care unit may be extended and additional treatment may be required. The overall length of your hospital stay varies depending on the rate of your healing. You will stay as long as the doctors think it is of benefit to you. The overall length of stay is usually between 10 to 14 days. Your length of stay may be extended depending on the severity of your pre-transplant condition and due to potential surgical complications.

Your recuperation continues after your discharge from the hospital. There will be certain restrictions on the activities of daily living for the first 4 to 6 weeks. In the early post-transplant period, you will come to the transplantation clinic on a weekly basis for laboratory tests and imaging studies, if required. The interval between your clinic visits will gradually increase, but you will remain under our follow-up at all times. In case of potential organ rejection or recurrence of your original disease, a liver biopsy may be required to confirm the preliminary diagnosis.

Alternative Treatment Options

In case of end-stage liver disease, an alternative treatment option similar to hemodialysis for kidney failure, unfortunately doesn’t exist. If the liver cannot produce albumin and prothrombin, has difficulties removing waste products (e.g. elevated bilirubin), or causes life-threatening complications (e.g. bleeding from a varicose vein, encephalopathy, impaired kidney and lung functions, fluid accumulation in the abdominal cavity and subsequent infection, etc.), the most effective treatment is the liver transplantation. All other treatments are provisional and aim to alleviate the symptoms.

There is ongoing contraversy about hepatocellular carcinoma (HCC) that originates from the liver itself. It is debatable whether surgically removing (resecting) the part of the liver affected by the cancer can be considered as an alternative treatment option. The determining consideration is whether the remaining part of the liver has sufficient volume and quality to sustain patient’s life. Thus, the resection option mostly applies to early stage hepatocellular carcinoma (HCC) (10%). This, on the other hand, means that the tumor is solitary and small, and the liver cirrhosis is still in the early stages. Another issue related to resection is that after the surgery, the remaining liver may still carry the disease. There is no guarantee that the cancer in the liver will not recur in the future. Historical data indicates a very high recurrence rate (>80%). On the other hand, liver transplantation in case of tumors that meet the Milan criteria (solitary tumor ≤ 5 cm, 2-3 tumors with largest ≤ 3 cm, absence of vascular invasion and extrahepatic disease) offers both the possibility to get rid of the cancer along with the diseased liver. The post-transplant survival rates are comparable to patients who had a transplant procedure without cancer. Nevertheless, the risk of recurrence cannot be completely eliminated and a small risk remains even after transplantations that meet the Milan criteria (10-14%). Please keep in mind that the recurrence rate increases as the Milan criteria are exceeded.

The choice between resection and transplantation depends on many factors including the size and number of the cancer, its relationship with blood vessels, presence of liver cirrhosis, its stage, if applicable, reserve, the likelihood of finding a cadaver organ or living donor in the country, etc. International practice guidelines offer recommendations that help to select the most appropriate care for the individual patient. In this context, Barcelona criteria are most commonly used. You may discuss the available options with your transplant surgeon.

Radiofrequency ablation (RF) and transarterial chemoembolization (TAKE)

Ablation of the cancer focus (RFA) or injecting a drug inside a tumor to shrink its size (TAKE) are procedures performed by the interventional radiology department. These, however, only offer a provisional solution. These options may be used as a last resort or to stop the growth of the cancer while waiting for a suitable cadaver organ. Sometimes, they are used to downsize the tumor so that a resection can be performed.

Ablating a tumor that lends itself to surgical resection (e.g. small and solitary) using RF, a non-surgical method, may be viable option, though not a very popular one.

Possible Medical and Psychosocial Risks

All surgical procedures, particularly the ones performed under general anesthesia, are associated with many risks. Most of the complications are minor and respond to treatment. Certain complications, however, may be very serious and result in return to surgery or require additional procedures. Blood and blood products that are used to compensate for the blood loss during transplant surgery may be contaminated with bacteria or viruses and cause infections. Although this is not a common occurrence, possible infections include, but are not limited to the following: HIV (human immunodeficiency virus), HBV (hepatitis B virus), and HCV (hepatitis C virus).

There may be delays in restoring the function of the transplanted liver graft. Such a delay not only extends your length of stay in the hospital, but also increases the risk of complications. The transplanted liver graft may fail to work. In this case, the patient may require a second transplant. If the emergency cadaver graft request criteria of the Turkish MoH are met, a request is made from the organ dispensing system. Under certain conditions, a living donor may be considered for the second graft. If a new liver graft is not found, there is risk of death. Primary non-function (PNF), failure of initial graft function, occurs in 2-3% of the cases. PNF requires emergent re-transplantation.

A blood clot blocking the hepatic artery, although rare, is another possible complication. Interrupted blood supply to the liver may lead to liver failure, liver abscess, and/or stenosis of the bile ducts. Most of the patients with a blocked hepatic artery require a second surgery or re-transplantation.

Many factors may be associated with confusion and mood disorders, including the fact that you undergo a major surgery as well as severity of the condition that required the transplant procedure, multiple drug use, use of blood and blood product, extended length of stay in the intensive care unit, and other complications. This phenomenon is usually metabolic in nature and short-lived and transient and resolves as you recover.

Some patients may experience leaks or stenosis of their bile ducts. Bile leaks usually resolve without a surgical intervention. Sometimes, a tube is inserted in the bile duct through the skin or mouth. Occasionally, a surgery may be needed to repair the bile leak.

Bile duct stenosis/stricture mostly occurs at the junction between the bile outlet of the transplanted liver and the bile duct of the recipient or intestine. Some strictures may be treated by inserting a plastic tube following balloon dilatation, but some require surgical repair.

The condition that necessitated the liver transplant may recur. Conditions that may recur include autoimmune hepatitis, hepatocellular cancer, hepatitis B and C. Until recently, in patients who had a liver transplant because of hepatitis C infection, the new liver was always reinfected with the hepatitis C virus. Today, however, hepatitis C is treatable and the virus can be completely eliminated. Moreover, liver grafts harvested from hepatisis C infected individuals are used for transplant procedures. Studies demonstrate that with appropriate therapy after the transplantation procedure, it is possible to eradicate the virus.

There are other complications associated with liver transplantation. These complications include bacterial, viral, and fungal infections, acute organ rejection, drug-related side effects, as well as many others. The drugs that are used to suppress your immune system may have many side effects. These include kidney problems, issues related to the gastrointestinal tract, abnormal blood test results, nervous system injury, high blood pressure, weight gain or loss, diabetes and many other similar complaints.

At any time after the transplant procedure, repeated biopsies, surgical or other types of procedures may result in extended length of stay in the intensive care unit or hospital.

There may be a slight increase in the rate of certain types of cancer due to immunosuppressive therapy (e.g. skin cancer and post-transplant lymphoproliferative disease or lymphoma).

Other Risks

In spite of compression devices and other precautions taken, a blood clot may form in the veins of your leg. This clot may break free and move to the heart and from there, to the arteries in the lungs resulting in a number of complications ranging from shortness of breath to death. You may be required to use drugs that prevent clotting of blood for an extended period of time (months).

There may be fluid accumulation especially in the right pulmonary cavity after the transplant. This condition is usually self-limited and does not require any treatment. Rarely, the amount of accumulated fluid may cause shortness of breath, which may require the insertion of a tube to drain the fluid.

The risk of infections is higher than other major surgical procedures. This is due to the immunosuppressive therapy that is administerd to prevent the cellular attack against the transplanted organ (rejection). This therapy diminishes the body’s ability to fight off germs and thus, increase your risk of infections. Our normal flora -especially the gut flora - already has many germs that have the potential to cause infections. Although this is not a concern in a healthy individual, it may be associated with serious infections in patients who had a major surgery, whose equilibrium is impaired and whose immune system is suppressed by both the liver disease as well as the medications given.

The surgical incision site on the abdomen, and the access points of the tubes and drains are other potential infection sites. The patient may develop pneumonia, bloodborne infections, or localized infections.

There may be a nerve injury. This may be the result of direct contact or occur in the arm, back, or legs because of positioning during surgery The symptoms are usually transient, but may rarely persist over a longer period of time or even become irreversible.

Other potential complications include: injury to intraabdominal structures, pressure ulcers due to patient’s position, burns caused by electrical instruments used during surgery (e.g. cautery), injury to arteries and veins, pneumonia, atalectasis (collapse of the lung), heart attack, stroke, permanent scars at the surgical site.

Risk Factors Related to the Organ Donor:

Certain donor-related conditions may interfere with the success of the transplant procedure. These include limited information about the medical history of the cadaver donor and the condition of the transplant graft. Although it is a common belief that the liver has not specific age, old livers are more susceptible to cold exposure and tend to be more fragile during surgery. In addition, there is the risk of becoming infected with HIV and other infectious agents that may not have been detected in the donor.

Right to Refuse the Transplantation Procedure

You have the right to refuse to be transplanted with the cadaver graft that is offered to you at any time. If you choose to refuse the transplant, the treatment for your existing liver condition will not be interrupted, but your condition will most probably deteriorate and you will have a shorter life expectancy.

Post-Liver Transplant Survival Rates at our Center and Globally

  • US Data:
  • Our center is a member of the European Liver Transplant Registry (ELTR) and based on data from 153 member centers from 23 countries:
  • Based on data from the Ankara Güven Hospital Liver Transplantation Program: 1-year and 3-year survival rates following a liver transplant are 85% and 76%, respectively

The 1-year and 3-year survival rates following a liver transplant are reported as 89% and 79%, respectively.

1-year and 3-year survival rates following a liver transplant are 86% and 78%, respectively.


SOME INFORMATION FROM GUVEN HOSPITAL'S INFORMED CONSENT FORM FOR LIVING DONOR HEPATECTOMY

II- INFORMATION RELATED TO LIVING DONOR HEPATECTOMY SURGERY:

I am at the Ankara Güven Hospital in order to be assessed as a potential living liver donor for a patient with end-sage liver disease. The team involved in the care of the potential recipient informed me that the best treatment option for the patient is liver transplantation. The aim of this document is to ensure that I am fully informed about the assessment process, transplant procedure, and expected long-term outcomes of the living donor surgery including its possible risks and benefits. This process is referred to as ‘informed consent’.

The Assessment Process and Liver Transplant Team

I was told that different procedures and consultations, including some laboratory tests, will be carried out to determine my eligibility as a liver donor and that I will meet the members of the liver transplant team. These include;

The Organ Transplant Coordinator who will inform me, the potential living donor, about the assessment process, and the process before and and after the surgery.

The Gastroenterologist who is involved in the assessment of my liver to determine my eligibility as a donor both functionally as well as anatomically.

The Transplant Surgeon uses the results of the assessment process to discuss my eligibility as a living liver donor with me. In addition, he provides information about the importance of the donor surgery, surgical risks, possible complications before and after the surgery. He will perform the surgery if I qualify as an eligible donor.

The Anesthesiologist will make an assessment and review my clinical information to decide whether additional procedures or tests are needed, and informs me about the risks and benefits of anesthesia.

The Specialized Unit Nurse has expertise in the care and management of transplant patients and will be in charge of and oversee all nursing care provided to me during your hospitalization.

The Dietician will assess my nutritional status and provides education on nutrition-related issues.

Experts from different departments are involved to provide consultation on the condition of my organ systems [psychiatrist, infectious diseases specialist, nephrologist, pulmonologist, cardiologist, hematologist, etc.] as part of the overall assessment of my eligibility for the planned procedure.

I am aware that if a medical reason that prevents me being a donor is identified during the assessment process, the process will be terminated by the Organ Transplant Team. I know that I will not be considered as an “eligible” potential donor until the assessment process is completed and the Organ Transplant Team that comprises the related members of the multidisciplinary Organ Transplant Team approves my eligibility. Moreover, in case I am approved as an eligible living liver donor, I agree to become a donor on a voluntary basis and of my own volition without expecting a financial compensation in return and my only motivation is my obvious emotional connection to the recipient.

If I don’t meet the legal requirements related to kinship by blood or marriage/law to become a living organ donor (4th degree relative), the transplantation procedure has to be approved by the Provincial Health Directorate’s Ethics Committee after I clinically qualify as an ‘eligible potential donor’. I am also aware that the legal requirements related to this procedure may be different from my native country.

I know that I can withdraw my consent at any stage of the process to avoid a possible harm to my health. I am also aware that Ankara Güven Hospital is required to provide an Independent Living Donor Advocate to support me during the assessment process and to ensure that my rights are protected.

I know that it is essential that I provide complete and accurate information about my past medical history and current health status along with my psychosocial history to the Liver Transplant Team. I understand that I am required to read, understand, and sign this consent form for the assessment process to start.

Donor Assessment Process

I am aware that after samples are collected for blood/urine tests and a chest X-ray and ECG is performed and no problem is identified, I will continue with the second phase of the assessment and that overweight, high blood pressure, and other issues in my medical history may increase the risk of developing complications or death. In addition to the tests below, I know that additional tests may be required:

ECG, echochardiogram, and if needed, nuclear exercise test,

MRI/MRCP,

Ultrasound examination of the liver,

Abdominal dynamic computerized tomography,

Liver biopsy

Moreover,

I may be asked to lose weight in case I am overweight.

I am aware that before and after the surgical procedure, I have to abstain from alcohol, smoking, and any other pleasure-inducing substances and drugs.

The results of my assessment will be reviewed by the Organ Transplant Board that comprises the members of the multidisciplinary Organ Transplant Team who will decide whether I meet the living liver donor selection criteria of the Ankara Guven Hospital.

I know that all potential organ donors are screened for infectious diseases and high-risk behavior which are critical for both my own as well as recipient’s safety. I may have a currently unidentified clinical condition that may jeopardize the safety of the recipient and outcome of the transplant procedure (e.g. an infection or cancer). I am also aware that the assessment process does not guarantee that any potential infectious disease in the donor or recipient is identified.

Psychosocial risks

I was told that donating a piece of my liver may be associated with transient or permanent psychosocial risks. My quality of life may suffer as a result of the ‘donation’ procedure. I was told that possible effects may include, but not limited to sleeplessness, anxiety, depression, worries about my general health status and my liver’s condition, suicidal ideation, concerns about body image, post-traumatic stress disorders, feelings of guilt, profound sorrow and grieving should there be a complication or recurrence of the disease or death of the recipient. I am aware that I may refer to the Organ Transplant Team for help and support should I suffer from anxiety, pressure, or distressed for any other reason.

Donating a piece of my liver may interfere with my activities of daily living and life style. My relationship with the recipient or my family and friends may be affected. This may enhance my relationship or in contrary, may result in tensions and alienation.

Risks associated with donor assessment process

I am aware that during the assessment, current or future liver diseases or other medical conditions are being investigated. I am also aware in spite of this assessment, there still is the risk of contracting a liver disease or other conditions that may require treatment in future. The risks inherent to the living donor assessment process include, but are not limited to the following:

  • An allergic reaction against the contrast media/dye that is injected in the blood vessels for radiographic examination.
  • Identification of a medical conditions that the organization is legally required to report,
  • Identification of a serious disease, and
  • Identification of a negative genetic condition that I was not aware of before.

A potential assessment benefit is that it might reveal a health problem that I may not be aware of and I might need treatment for. I am aware, however, that a health-related problem that is identified may have a negative impact on applications for health insurance.

Surgical procedure and its risks

The surgical procedure that will be performed on me is called partial hepatectomy (removal of part of liver). I have learned that this surgical procedure is safely and commonly used for the treatment of both benign and malignant forms of liver cancer. However, as for any kind of major surgery, partial hepatectomy also carries significant risks, including death.

I know that this surgery will be performed under general anesthesia (putting the patient to sleep with drugs), I won’t feel any pain and my body will be immobile. In addition, I also know that at the intensive care unit where I will be admitted to after the surgery, I will be connected to an artificial ventilator machine until I wake up and regain my consciousness and mobility.

During the surgery, the surgeon will access my abdominal cavity through an incision and remove a part of my liver that is suitable for the recipient using a surgical technique. I learned that a plastic tube that speeds up my healing process by draining out any blood or bile leaks from the excision site of my liver will be placed in the surgical site on my abdomen.

I consent to the termination of the surgery if the surgical team decides that a high-risk situation may emerge or the liver tissue to be removed is not suitable for the transplantation. I have learned that this may happen in 2-3% of the cases.

I am aware that abdominal surgery carries many general risks. These complications include, but are not limited to the following: anesthesia complications, fever, pneumonia, urinary tract infection, abdominal bloating, nause, ileus (slowing down or absence of bowel movements), bowel obstruction or perforation, heart attach, cardiac arrhythmias, cardiovascular collapse (sudden circulatory failure), wound infection, persistent numbness and irritation at the incision site, systemic infection, hernia, intraabdominal adhesions, nerve damage caused by positioning, pain, weakness, incision scars on the skin, diaphgramatic perforation (diaphragm is the muscle layer that separates the thoracic and abdominal cavities), bleeding that may require use of blood, risks associated with the use of blood and blood products, intraabdominal organ injury, fluid accumulation, formation of a blood clot in the leg vessels, and if the blood clot breaks loose, it may travel to the heart and from there to the lungs (pulmonary embolism). I understand that pulmonary embolism is a potentially fatal serious condition. To prevent the formation of this dangerous blood clot, I may be given blood thinners, I may have to use compression stockings, and early ambulation after the surgery will be encouraged.

A blood transfusion may be needed during or after the surgical procedure. I was told that before the surgery, a couple of units of my blood may be collected and stored in the blood bank to be used later if a need arises. I also consent to the use of additional blood and blood products from a compatible donor if needed at the doctor’s discretion. I am aware of the potential risks associated with the use of blood and blood products. Although any blood that is transfused is first screened for HIV, hepatitis, and other infectious diseases, I am aware that there is still a small risk that I might become infected with ‘something’ that could not be detected.

I understand that there are risks specific to liver surgery, and to partial hepatectomy in particular. These risks include, but are not limited to the following: bile leak, stenosis of the bile duct, complications related to blood vessels of the liver, liver failure that may require emergent liver transplantation, and death during or after surgery.

I know that bile leak is the most common complication of partial hepatectomy with a global incidence of 5 to 15%. I learned that most leaks are identified when (green-yellowish) bile flows into the bag through the tubes that come out of the abdomen in the early postoperative period and most are self-limited and don’t require a surgical intervention while some may be closed using endoscopic or interventional radiological methods. I know that the tube that comes out of my abdomen (drain) will be left in place until the doctors are confident that the bile leak has stopped, which may extend my stay in the hospital and the follow-up period. There may be a need for repeated endoscopic and interventional radiological procedures. I was told that, although uncommon, biliary strictures (narrowing of the bile duct) following partial hepatectomy procedure. If this happens, it may necessary to dilate the constricted bile duct using endoscopic and/or interventional radiology methods and place a stent or catheter in the stenotic area. I am aware that surgical revision (repair) may be needed if the leak or stricture persists in spite of all non-surgical interventions.

Based on international reports and related statistics, the risk of developing a (minor/major) complication following partial hepatectomy is approximately between 15 to 40%. Many of these problems are minor and self-limited complications. Rarely, there may be a need for an additional or corrective surgery.

The Organ Transplant Team, as part of the assessment process, will check the size and functions of my liver to decide whether a piece of it can be removed safely. The doctors will decide which part of my liver is to be removed. I know that usually the right side of the liver is removed to be transplanted to adult recipients. I am aware that removal of part of my liver will temporarily reduce my liver capacity. Depending on the size of the removed tissue, my liver function may be temporarily impaired. In a couple of weeks, the remaining part of my liver will significantly grow albeit not to its original size and shape. I understand that I may develop liver failure after a piece of my liver has been removed. I am aware that this is a serious condition that may require emergent liver transplantation or result in my death. I have learned that this is a very rare complication that is seen in approximately 2 out of 1000 living donor partial hepatectomy procedures (0.2%).

Postoperative Care and Healing

After the surgery, I will be admitted to the intensive care unit for close monitoring. During my admission, I will have multiple tubes and drains on my body, wear stockings that prevent blood clot formation, and be connected to an artificial ventilator.

I am aware that I may have pain immediately after the surgery. My pain will be closely monitored and controlled. Pain killers are used to reduce pain to a level that doesn’t interfere with my deep breathing while I recover from anesthesia and to give me comfort. I was told that I may experience some degree of confusion because of the drugs that are used.

When my general condition becomes stable, I will be transferred to the transplant unit. The overall length of your hospital stay varies depending on the rate of my healing. I will stay in the hospital as long as my doctors believe it’s for my benefit. I have learned that the average length of stay in the hospital for living donors is 4 to 7 days.

The healing process will continue after my discharge from the hospital and my activities of daily living will be limited for the first 3 to 6 weeks. Most of the donors report to become relatively pain-free after 3 to 4 weeks. During my recovery, the transplant team will closely monitor the process. I was told that under normal conditions, I will be able to return to my baseline mobility level in approximately 8 to 12 weeks. I am aware that I will have to adapt to a liver-protective life style (maintaining a health weight, avoid excessive alcohol consumption, etc.).

In case I am of child-bearing age, I am aware that liver donation is not possible during pregnancy. I know that I have to inform the organ transplant team immediately about a possible pregnancy during the assessment or at my admission for surgery. I am advised to avoid becoming pregnant during my recovery.

Benefits and Consequences for the Recipient

By donating part of my liver, I know that I provide a number of benefits for the recipient. For example, this will give him/her the opportunity to schedule the time of the transplantation procedure (many patients on the waiting list die while waiting for a cadaver organ). On the other hand, I know that receiving an organ from a living donor carries certain risks for the recipient. For instance, with part of the liver instead of the whole, the recipient agrees to have a more challenging surgery.

He/she may not regain his/her previous health in spite of my donation. He/she may die due to surgical complications or his/her pre-transplant condition may recur (e.g. cancer, hepatitis, or use of alcohol/drugs). Or the recipient’s body may reject the transplanted liver. Moreover, the amount of transplanted liver tissue may not be sufficient for patient’s recovery (it may be too small to meet the recipient’s needs). He/she may develop liver failure and included in the waiting list for transplantation. He/she may die while waiting for a cadaver organ. This may have negative effects on my psyche.

Financial and Business-Related Concerns

I am aware that the assessment process and in case I qualify, the partial hepatectomy that will subsequently be performed may affect my future health and life insurance applications. I also know that being a living liver donor may result in losses at work and income and may negatively affect my future job applications.

Follow-up

After my discharge from the hospital, I know that I will be followed up as required by the Social Security Institution (SGK).

I agree that in case a condition is identified during the assessment and follow-up process, it may be reported to the related authorities as required by the MoH. I know that I am required to report medical conditions such as infections or cancer that I may have in the 2 years following the transplant to the Organ Transplant Team for the benefit of the recipient.

I am further aware that the kidney tissue that I have donated may not function, and the recipient may die during or after the surgery as a result of a serious complication.

Liver Transplant Survival Rates at our Center and Globally

  • US Data:
  • Our center is a member of the European Liver Transplant Registry (ELTR) and based on data from 153 member centers from 23 countries:
  • Based on data from the Ankara Güven Hospital Liver Transplantation Program: 1-year and 3-year survival rates following a liver transplant are 85% and 76%, respectively
  • 85% of the liver transplants at our center were performed using livers donated by living donors. Peri-operative mortality related to the surgery is 0%. Bile leak was identified in 8% of the donors and all of them recovered. In half of the donors, endoscopic or radiological procedures were performed during their recovery.

The 1-year and 3-year survival rates following a liver transplant are reported as 89% and 79%, respectively.

1-year and 3-year survival rates following a liver transplant are 86% and 78%, respectively.



Services

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  Phone in the room
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  Airport pickup
  Accommodation for patient relatives
  Cafe
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  Nursery / Nanny services
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Güven Hospitals


Contact

00 90 312 457 25 25

Şimşek Sokak No:29 Kavaklıdere ANKARA