A kidney transplant ends dialysis and lengthens life, with long-term death rates 48 to 82 percent lower than staying on the waiting list, and it works better still before dialysis starts. We explain living donation from relatives, the donor's real risks, the legal rules for foreign patients, the operations and a four to six week stay.
About This Department
Organ Transplantation
For kidney failure, a transplant outlives dialysis. Done before dialysis starts, it works better still.
A kidney transplant places one healthy kidney, from a living relative in the case of most international patients, into the lower abdomen of a person whose own kidneys have failed. It frees the patient from dialysis and lengthens life. In a study of 228,552 American dialysis patients, those who received a transplant had a long-term death rate 48 to 82 percent lower than similar patients who stayed on the waiting list. One kidney is enough for the donor. Among 80,347 living donors, 3.1 in 10,000 died from the operation, and long-term survival matched that of healthy people who had not donated.
48 to 82% lower
Long-term death rate after transplant against staying on dialysis, NEJM 1999
3.1 in 10,000
Donors who died from the operation, JAMA 2010
31% lower
Risk of death with a living donor transplant before dialysis, J Am Soc Nephrol 2002
Free
Transplant team review of your reports
Free consultation
Send the patient's recent creatinine and eGFR, the cause of kidney failure if known, whether dialysis has started and since when, the blood group, and any heart or diabetes reports. For each relative willing to donate, send age, blood group, relationship and any known illnesses. The transplant team replies with whether a transplant fits, which relatives look suitable, and what the legal and medical steps would be. The review is free, and nobody is committed to anything by it.
When the kidneys fail, there are three treatments, and only one of them replaces the kidney. This page on kidney transplant surgery sets out why a transplant beats the other two for most patients, who can receive and who can give, what donation means for the donor over a lifetime, the law for international patients, the evaluation and operations, and the weeks a family should plan to spend in Istanbul.
Transplant or dialysis
Three options, and they are not equal.
1
Hemodialysis
A machine cleans the blood three times a week for about four hours at a time, through a fistula in the arm or a catheter. It keeps patients alive but ties them to a center and a timetable.
2
Peritoneal dialysis
Fluid run into and out of the abdomen at home, several times a day or overnight by machine. More freedom, similar long-term results to hemodialysis.
3
Transplant
One working kidney replaces two. No dialysis, fewer diet limits and, in most patients, a longer life, at the price of daily medicines.
Transplant recipients lived longer than those who stayed on the list
A study of 228,552 dialysis patients followed 46,164 who joined the waiting list, 23,275 of whom received a deceased donor kidney. Risk of death was higher in the first two weeks after surgery, equal within a few months, and far lower afterward, with a relative risk of 0.32 at 18 months. Long-term death rates were 48 to 82 percent lower than for those still waiting. Wolfe and colleagues, New England Journal of Medicine, 1999.
Who can receive and who can give
Age alone rarely rules anyone out.
The recipient
Adults and children with kidney failure, on dialysis or close to it, whose heart and blood vessels can withstand the operation and who can take the medicines reliably. People in their seventies receive transplants when they are otherwise fit. Active cancer, a serious infection or severe heart disease that cannot be treated usually rules it out, at least for a time.
What must be treated first
Heart disease is checked thoroughly, since it causes most deaths after transplant. Infections such as hepatitis B and C, tuberculosis and dental abscesses are treated. Blocked arteries in the pelvis, where the new kidney connects, are imaged. Very high body weight may need reducing before surgery.
The donor
What donors need
Be an adult, usually 18 to about 65, in good health.
Have two normal kidneys of similar function, confirmed by scan and tests.
Have no diabetes, uncontrolled high blood pressure, significant kidney disease, active cancer or major heart disease.
Give free, informed consent, with the right to withdraw at any stage.
Blood group and crossmatch
Donor and recipient blood groups should be compatible, as for a transfusion. A crossmatch test mixes the recipient's blood with the donor's cells to check for antibodies that would attack the kidney at once. When groups or antibodies do not match, some centers use desensitization treatments before surgery, and the team explains whether this is possible.
What donating a kidney means
A donor accepts a small risk for someone else's benefit. The numbers below come from the two largest studies of American donors, and every potential donor should see them before deciding.
What the numbers show
In the short and the long term
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Risks of living kidney donation
Question
Donors
Comparison
Death from the operation, within 90 days
3.1 in 10,000 among 80,347 donors
Higher in men and in donors with high blood pressure
Long-term survival
No worse than matched healthy non-donors over a median of 6.3 years
Segev and colleagues, JAMA 2010
Kidney failure within 15 years
30.8 in 10,000 among 96,217 donors
3.9 in 10,000 in matched healthy non-donors
Estimated lifetime kidney failure
90 in 10,000
14 in 10,000 healthy non-donors, 326 in 10,000 in the general population
Donation law for international patients
Kidney donation in Turkey follows strict rules designed to protect donors.
Who may donate
Relatives and spouses may donate with proof of the relationship. A donor outside the family needs the approval of an ethics committee, which confirms that no money, pressure or promise lies behind the offer. Deceased donor kidneys are allocated through the national system, so international patients come with their own living donor. Selling or buying a kidney is illegal in Turkey and almost everywhere else.
The papers to prepare
Passports or identity documents for patient and donor, official documents showing the relationship, such as birth or marriage certificates or a family register, translated and certified in the home country, and in some cases a statement from the consulate. The coordinator checks the file before anyone books a flight.
The evaluation, step by step
Two to three weeks, in parallel for both.
1
Blood group and crossmatch
The first test, since it decides quickly whether a donor can go further.
2
Donor health checks
Kidney function measured precisely, urine tests, blood pressure over a day, a CT of the kidneys and their vessels, and heart and lung checks.
3
Recipient checks
Heart tests, scans of the pelvic arteries, infection screening, dental and gynecological checks, and cancer screening by age.
4
Psychology and consent
Separate interviews, an independent doctor for the donor, and a pause before signing.
Why earlier is better
A transplant before dialysis protects both kidney and patient
Among 38,836 first kidney transplants, those done before dialysis started had a lower risk of the new kidney failing, relative risk 0.73 with a living donor, and a lower risk of death, 0.69 with a living donor. Kasiske and colleagues, Journal of the American Society of Nephrology, 2002.
What this means for planning
When a relative is willing to donate, referral should come when kidney function falls to around 20 percent, before dialysis is needed, so that the evaluation and surgery can be done in time. For patients already on dialysis, a transplant remains far better than staying on it.
The two operations
Both run on the same morning, side by side.
Donor and recipient
The donor operation
The kidney is removed by keyhole surgery in most cases, through three or four small incisions and a slightly larger one low on the abdomen to lift it out. It takes two to three hours. Most donors walk the same evening and leave hospital in two to four days.
The recipient operation
The new kidney is placed in the lower abdomen, on the right or left, and joined to the pelvic artery and vein and to the bladder. The patient's own kidneys usually stay in place. It takes three to four hours, and in most cases the kidney starts making urine on the operating table.
Recovery in hospital and after
The first days decide a great deal. Creatinine, the waste product that tells how well the kidney filters, falls over hours to days as the new kidney takes over, and the team watches it every morning. Urine output is measured hour by hour at first. Fluids and blood pressure are balanced carefully, because the new kidney dislikes both dehydration and overload, and the patient is helped out of bed on the first day to protect the lungs and legs.
In hospital
The first week
Blood tests every day to watch creatinine fall, a urinary catheter for a few days, a thin stent in the new ureter removed a few weeks later, and the start of anti-rejection medicines. Some deceased donor kidneys and a few living donor kidneys take days to start working, and short-term dialysis bridges the gap.
The first weeks
1
Discharge
After about a week for the recipient, with a written medicine schedule.
2
Clinic checks
Two or three times a week for the first month, with blood tests and drug levels.
3
Stent removal
A short cystoscopy at four to six weeks.
Anti-rejection medicines and complications
Medicines protect the kidney for as long as they are taken.
What patients take
The daily schedule
Tacrolimus, measured in the blood regularly, with mycophenolate and usually a low dose of steroid. Antibiotic and antiviral tablets for the first months to prevent infections. Doses are adjusted to keep rejection away while limiting side effects such as infection, high blood sugar, raised blood pressure and tremor.
What can go wrong
Rejection, usually caught by a rise in creatinine and treated with extra medicine. Infections, especially in the first six months. Leakage or narrowing where the ureter joins the bladder. A blood clot in the kidney's artery or vein, which is rare but can cost the kidney if it is not treated within hours. In the long run, a higher risk of skin cancer, so sun protection matters.
Length of stay, flying and cost
Donors and recipients leave at different times, and the family plans around the longer of the two. A companion who stays with the recipient for the whole period, helps with the medicine schedule and comes to every clinic check makes the weeks after surgery far easier, and in practice the families who arrive with that arrangement in place are the ones whose recoveries run most smoothly.
Plan four to six weeks in Istanbul for the recipient, including the evaluation.
Plan two to three weeks for the donor, who can fly once the wound check is done.
Keep a companion with the recipient throughout.
Three things drive cost. Desensitization, if needed, the length of the hospital stay, and the medicines of the first weeks. Published packages in Istanbul cover the evaluation of both, both operations, the hospital stay within stated limits, an interpreter and transfers. Hotel stays during follow-up and flights are extra, and a written estimate follows the evaluation, while the first review of the reports costs nothing. The coordinator works in English, Arabic, French, Russian, Serbian, Romanian or Spanish, or with an interpreter, checks documents before travel, sends invitation letters naming the hospital and the treating doctor for patient, donor and a companion, and books hotels near the hospital. Halal, vegetarian and diabetic meals are available, a prayer room is on site, and you may request a female doctor at first contact.
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A typical kidney transplant timeline
Stage
Recipient
Donor
Evaluation
Two to three weeks
Two to three weeks, in parallel
Hospital stay
About one week
Two to four days
Nearby follow-up
Two to three weeks more
Until the wound check
Flying home
Four to six weeks after arrival
About two to three weeks after arrival
Follow-up at home
Back home, a nephrologist becomes the transplant's guardian. Local care matters.
A written plan for your kidney doctor
Once you are back home, a nephrologist there follows the plan, with creatinine and drug levels weekly at first, then monthly, then every few months. The transplant team reviews results on request, and the coordinator stays reachable on the same WhatsApp number.
See a doctor the same day for fever, less urine than usual, pain or swelling over the new kidney, a sudden rise in weight or blood pressure, or vomiting that stops you taking the medicines.
Kidney Transplant Surgery FAQ
Is a kidney transplant better than dialysis?
For most patients, yes. In a study of 228,552 dialysis patients, the long-term death rate after transplant was 48 to 82 percent lower than for those who stayed on the waiting list, and transplant ends dialysis.
Can a foreigner get a kidney transplant in Turkey?
Yes, with a living donor. Relatives and spouses can donate with proof of the relationship, other donors need ethics committee approval, and deceased donor kidneys go through the national system.
Is it safe to donate a kidney?
The risk is small but real. Among 80,347 donors, 3.1 in 10,000 died from the operation, and long-term survival matched healthy non-donors. The lifetime risk of kidney failure rose from about 14 to about 90 in 10,000.
Should a transplant be done before dialysis?
When possible, yes. Transplants done before dialysis had a lower risk of kidney failure and of death in a study of 38,836 patients.
How long do patient and donor stay in Istanbul?
About four to six weeks for the recipient and two to three weeks for the donor, including the evaluation.
How long does a transplanted kidney last?
Many work for fifteen years or more, living donor kidneys longer on average than deceased donor kidneys. Taking every dose of the anti-rejection medicines is the single most important factor.
References
Wolfe RA, Ashby VB, Milford EL, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341(23):1725-30.
Segev DL, Muzaale AD, Caffo BS, et al. Perioperative mortality and long-term survival following live kidney donation. JAMA. 2010;303(10):959-66.
Muzaale AD, Massie AB, Wang MC, et al. Risk of end-stage renal disease following live kidney donation. JAMA. 2014;311(6):579-86.
Kasiske BL, Snyder JJ, Matas AJ, et al. Preemptive kidney transplantation, the advantage and the advantaged. J Am Soc Nephrol. 2002;13(5):1358-64.
Editor's note
Written by the Biruni Hospital medical editorial team. Reviewed by Assoc. Prof. Dr. Münir DEMİREL, Oral and Dental Health.
