Liver exchange in Turkey

Here's a forthcoming article in the AJT, reporting on a collaboration between physicians and market designers with experience in kidney exchange:

The First 4-Way Liver Paired Exchange from an Interdisciplinary Collaboration between Healthcare Professionals and Design Economists by Sezai Yilmaz, MD, FACS  Tayfun Sönmez, PhD  M. Utku Ünver, PhD  Volkan Ince, MD  Sami Akbulut, MD, FACS  Burak Isik, MD  Sukru Emre, MD  American Journal of Transplantation, BRIEF COMMUNICATION|ARTICLES IN PRESS, Open Access Published: July 05, 2023 DOI:https://doi.org/10.1016/j.ajt.2023.06.016 

Abstract: We report initial results of a Liver Paired Exchange (LPE) program established at the Liver Transplant Institute at Inonu University through collaboration with design economists. Since June 2022, the program has been using a matching procedure that maximizes the number of living donor liver transplants (LDLTs) to the patients in the pool subject to the ethical framework and the logistical constraints of the program. In one 4-way and four 2-way exchanges, twelve LDLTs have been performed via LPE in 2022. The 4-way exchange, generated in the same match run with a 2-way exchange, is a first worldwide. This match run generated LDLTs for six patients, revealing the value of the capacity to carry out larger than 2-way exchanges. With only 2-way exchanges, only four of these patients would receive LDLT. The number of LDLTs from LPE can be increased by developing the capacity to perform larger than 2-way exchanges in either high-volume centers or multi-center programs.

 

Kidney exchange in Turkey: a decade of experience at a hospital in Istanbul

 Here's a recent article, from Bahcesehir University Goztepe Medicalpark Hospital Transplant Center,  in Istanbul which has a decade of experience in kidney exchange. It's main point is that Turkey needs more kidney exchange, organized on a larger scale, because the deceased donor system there is very limited, so transplants primarily involve living donors. 

Long-Term Outcomes of Kidney Paired Donation Transplantation: A Single Center Retrospective Cohort Study, by Eda Altun and Melike Yavuz  In Transplantation Proceedings. Elsevier, 2023.

"In this single-center, retrospective, cohort study, we analyzed 141 KPD transplant patients from July 2011 to June 2020 at Bahcesehir University Goztepe Medicalpark Hospital Transplant Center, Istanbul, Turkey.

...

"Although the current study is based on a single-center's records, the findings suggest that the long-term outcomes of the KPD program were similar to conventional LDKT. These results demonstrate that KPD is practicable, thriving, and successful if performed to a more extensive donor list. Efforts should be made to expand the KPD program in countries such as Turkey, where cadaveric transplantation is insufficient. "

***********

Earlier:

Friday, July 24, 2015

Kidney exchange in Turkey, and the state of Turkish transplantation

Tuesday, February 3, 2015

Organ donation in Turkey

Wednesday, November 21, 2018

Kidney exchange in Turkey, some recent reports

Kidney exchange in Turkey, some recent reports

Here are an academic paper on the kidney exchange program at Baskent University, and a news story about a kidney exchange in Turkey between two Ukranian patient-donor pairs:

Our Experience with Paired Kidney Exchange Transplantation
Haberal, Mehmet; Akdur, Aydincan; Karakayali, Feza Yarbug; Ozcelik, Umit; Moray, Gokhan; Kulah, Eyyup; Inal, Ali; Torgay, Adnan; Arslan, Gulnaz
Transplantation: July 2018 - Volume 102 - Issue - p S499

"Seven pairs were matched from July 2015 to September 2017 and we performed 14 PKE (5 women, 9 men) transplants. Mean recipient age was 49.8±11.5 (range: 23-61) and mean donor age was 50.4± 12.4 (range: 38-64) years. Five of the donors were fathers, one of them was a mother, 3 were husbands and 5 were wives. Mean mismatch ratio was 5±1 (range: 3-6). Reason for exchange was ABO incompatibility for 10 patients and positive crossmatch and presence of donor specific antibodies for 4 patients. All were 2-way donations. Median waiting time for getting suitable donor after registration was 3 months. Two of the recipients were retransplanted and desensitization with plasmapheresis was needed for panel reactive antibody positivity. One patient underwent preemptive kidney transplant.
...
"ABO incompatibility continues to pose a serious problem for transplantation candidates, especially in kidney and liver transplants. Our small series shows that PKE transplantation is an alternative for patients without a viable living-related donor or deceased compatible donor organ."
************

Kidney swap in Turkey offers new life to 2 Ukrainians
Coming from Ukraine, Valeriy Horobets, Viacheslav Shcherbyna undergo paired kidney exchange surgery in Istanbul, October 16, 2018

At Medicana International Istanbul Hospital ,
"Two Ukrainian citizens welcomed their new lives in Turkey after a cross-kidney transplant surgery in Istanbul."

Turkey to toughen laws on surrogacy, which contains "elements of adultery."

Turkey to toughen laws on surrogacy
The URL is more graphic than the headline: http://www.al-monitor.com/pulse/originals/2017/09/turkey-to-introduce-jail-for-surrogate-mothers.html

"Under the present law, surrogate motherhood is in a gray area. The 282/1 article of the Turkish Civil Code says that the relationship between mother and child is established through birth. This means that surrogate motherhood “has no basis in Turkish law” and that the surrogate mother is the mother. Should a couple try to have a child by a surrogate mother, establishing parenthood becomes a legal muddle. In vitro fertilization, on the other hand, is possible, and there are regulations in the Turkish bylaws about Assisted Reproduction and Infertility Centers, which can be used by married couples only.

If they want to have a child through a surrogate mother, most Turks simply choose to go abroad and come back with a baby, which they have registered under the name of the genetic parents. There are numerous stories about couples who go to Northern Cyprus, Ukraine or Georgia, where surrogacy is legal. Allegedly, the price for the process varies from $40,000 to $70,000. A simple Google search results in a list of websites of companies that advertise surrogate motherhood as part of their services. Turkish media has in the past published some personal stories of women who decided to become surrogate mothers in Northern Cyprus, describing the process and explaining the uneasy choices and decisions.

But the new law, reported by Hurriyet journalist Meltem Ozgenc, aims to fill in the gray area and ban surrogate motherhood altogether, including abroad, by Turkish citizens. It also bans “mediation,” “assistance,” “encouragement” or “advertisement” for surrogacy.

According to information that Al-Monitor has obtained, several provisions will be added to the current Law No. 2238 on the “Harvesting, Storage, Grafting, and Transplantation of Organs and Tissues.” The revision of the law is expected to pass within the scope of one of the upcoming decrees by the power of law — the main ruling mechanism since the government declared a state of emergency in July 2016 after the attempted coup.

The new draft law says: “Having a child or serving as a surrogate mother is banned if the pregnancy is undertaken through the reproductive cells taken from one or both of the partners, or if the embryo acquired from these cells are inseminated into others.”

According to the Hurriyet Daily News, the new draft law prohibits “undertaking a donation procedure to use someone else’s reproductive cells or embryo, as well as to donate, sell, use, stock, transfer, import and export reproductive cells or embryos for this purpose.”

The draft’s last paragraph adds that the penalties foreseen in the law are applicable even if the surrogacy takes place in a country where it is legal.

Besides introducing prison time between two to five years for those involved in surrogate motherhood, the law also clarifies legal eligibility for in vitro fertilization. More precisely, the additions to the existing legislation would confirm that the in vitro fertilization process could be applied if the couple cannot have a child in natural ways and if there is a medical necessity. Yet the procedure would be allowed just for married couples, and it can only be performed in licensed centers and by medical professionals granted authority by the Ministry of Health.

The emphasis on married couples is undoubtedly in line with mainstream Sunni religious interpretations of Islam in Turkey, as the statements by the country’s top religious affairs body have confirmed in the past. In 2015, the High Council’s platform of the Directorate of Religious Affairs (Diyanet) said that in vitro fertilization between unmarried individuals “offended humane feelings and contained elements of adultery.” At the same time, it was stated that surrogate motherhood is also deemed religiously unacceptable, as it is viewed to contain elements of adultery. This view has been confirmed by some prominent religious figures, including Hayrettin Karaman and renowned televangelists such as Nihat Hatipoglu.

The adultery argument is a common basis for banning surrogacy within Sunni Islam, as the sperm of a man is introduced into the uterus of a woman other than his wife, which is prohibited by verses in the Quran. Other reasons for banning surrogacy, according to Ruaim Muaygil, are “preservation of lineage, exclusion of third parties in reproduction, upholding the rights of the child and protection from the negative effects of surrogacy.” On the other hand, more progressive professionals and scholars such as Muaygil clarify between traditional and gestational surrogacy, and use Islamic law and bioethics alongside medical evidence to show that “surrogacy is not only consistent with Sunni Islamic teachings, but is also both ethically justified and medically necessary.”

Who Gets What and Why, in Turkish: Kim Neyi Neden Alır?

The Turkish translation of Who Gets What and Why is now available:

Kim Neyi Neden Alır?

Here's what appears to be a pre-publication review.

And here's what appears to be an early review of the published book:

Eşleştirme Ekonomisi ve kim, neyi, neden alır?

Kidney exchange in Turkey, and the state of Turkish transplantation

Here are two articles from the June issue of Transplantation Proceedings

First International Paired Exchange Kidney Transplantations of Turkey    

M. Tuncer

, S. Tekin

, Y. Yuksel

, L. Yücetin

, L. Dosemeci

, A. Sengul

 and A. Demirbaş

Transplantation Proceedings, 2015-06-01, Volume 47, Issue 5, Pages 1294-1295, Copyright © 2015 Elsevier Inc.

Abstract

Objective

We estimated that many patients on the waiting list for kidney transplantation in Turkey have immunologicaly incompatible suitable living donors. Paired exchange kidney transplantation (PETx) is superior to desensitization for patients with incompatible donors. Recently we decided to begin an international PETx program.

Methods

We report three international living related paired kidney transplantations which occurred between May 14,2013, and March 7, 2014. The international donor and recipient operations were performed at Medical Park Hospital, Antalya, Turkey. All pairs were living related and written proofs were obtained according to Turkish laws. As with the donor procedures, the transplantation procedures were performed at the same time.

Results

The uniqueness of these transplantations was that they are the first international exchange kidney transplantations between Turkey and Kirghizia. Currently all recipients are alive with wel-functioning grafts.

Conclusion

In our institute, a 5% increase was obtained in living-related kidney transplantations by the help of PETx on a national basis. We believe that international PETx may also have the potential to expand the donor pool.

***************

State of Turkish Transplantation    

• Sukru H. Emre Prof.
•  and Ulug Eldegez Prof.

Transplantation Proceedings, 2015-06-01, Volume 47, Issue 5, Pages 1243-1243, Copyright © 2015 Elsevier Inc.

The 10th Congress of the Turkish Transplantation Centers Coordination Association (TTCCA) was held on October 15–18, 2014 in the ancient city of Bodrum, Turkey (formerly Halicarnassus), where one of the Seven Wonders of the Ancient World, “Mausoleum at Halicarnassus,” resides.

This congress also marked the 20th anniversary of the TTCCA. Since its inaugural meeting, TTCCA's congresses have hosted international leaders in the fields of transplantation in transplant immunology, hepatology, nephrology, surgery, radiology, infectious disease, intensive care, nursing, and other related disciplines. Throughout the years, these congresses have served as a great training ground for young Turkish physicians, surgeons, and scientists to meet with world experts and discuss cases. These congresses have also helped Turkish physicians develop international networks so that they may visit transplant centers around the world.

Twenty years ago, TTCCA was established by two pioneers of Turkish transplant surgery: Professors Tuncer Karpuzoglu and Ulug Eldegez. These men were the ones who approached the young transplant surgeons, physicians, immunologists, and nurses to welcome them, encourage them, guide them and point them in the right direction. TTCCA has had bi-annual national meetings since its inception. These meetings have brought almost all transplantation centers in Turkey together under the TTCCA and initiated a nationwide deceased organ distribution system for kidney, liver, and heart transplantations. This effort was sponsored by a grant provided by Novartis. This was the first attempt in Turkey to institute the equal, fair sharing of organs procurred from deceased organ donors. After almost 10 years of serving in this capacity, TTCCA partnered with the Ministry of Health of Turkey (MoH) to achieve the current organ allocation system. During the development of the new organization under the auspices of the MoH, TTCCA leadership and many members have played crucial roles by serving on many committees of this national organization.

As a result of these efforts ignited by TTCCA, solid organ transplantation in Turkey has became a routine procedure with reasonably good outcomes.

Despite these achievements, there are many areas that the transplantation society and MoH can work on:

• 1. 
  Based on the 2014 statistics, approximately 80% of kidney and liver transplants were done with living donors and only 20% of organs were from deceased donors. In living donor liver transplantation, Turkey is the one of the leading countries in the world together with South Korea. These ratios are the opposite to the ratios of Europe and the US where most of donations are from deceased donors. Therefore, there is an ample opportunity to increase deceased organ donation in Turkey. This effort requires continuous education of the public on organ donation.
• 2. 
  It is imperative to establish a Turkish Transplantation Network similar to UNOS. Besides what has been achieved, this organization should be in charge of increasing the number of deceased donors, more detailed organ specific data from transplant centers, auditing, controlling the quality of transplant centers in terms of policies, processes, quality and accreditation of medical and surgical staff involved in transplant centers, education, and monitoring transplant related disease transmission.

TTCCA and MoH have been working with The Transplantation Society (TTS), World Health Organization (WHO), EuroTrans and the Declaration of Istanbul on Organ Trafficking and Transplantation Tourism leadership to honor the concept of the “gift of life,” prevent organ trafficking and increase the number of deceased donors for transplantation. I hope that these commendable efforts would be honored by TTS by allowing the 2020 World Congress to be held in Istanbul, Turkey.

It has been my pleasure to live through these amazing improvements in Turkish Transplantation along the last 20 years.

Organ donation in Turkey

The religious debate about organ donation in Turkey may have reached a turning point. Here's a story from the Daily Sabah:

Imams to lead organ donation efforts in Turkey

"Yesterday, Turkey's Presidency of Religious Affairs (DİB) launched a new campaign for imams to raise awareness about organ donation, while DİB head Mehmet Görmez urged imams to donate their organs first before advising the congregation to do so.

"DİB, the top religious authority in the country, quashed a religious debate on whether donating organs is permissible in Islam by introducing a new campaign to raise public awareness about organ donation.

"Görmez and Minister of Health Mehmet Müezzinoğlu attended a meeting in order to inform religious figures on the matter in the Turkish capital Ankara.

"Görmez called upon imams, muftis and other members of the religious authority "to practice what they preached" and donate their own organs. "Sometimes, clerics fail to act in line with advice they dispense to their congregation. On this issue, we should lead the people. I call on my colleagues to tell their congregation in the sermons that they have donated their organs," Görmez said. "This will make people attending mosques heed your advice," he added.

"It is the greatest alms one can deliver from the heart," he said. Görmez said he found it odd that organ donation has been the subject of contention for decades among clerics. "Life, value of a human being's life are at the center of all religions," Görmez said. He quoted a verse from the Quran that says that killing someone is equal to killing humanity and giving life to another is equal to giving life to humanity."