Kidney transplant (living donor)

A kidney transplant is an operation that places one healthy kidney from a donor into a person whose own kidneys have stopped working well enough to keep them alive. The kidneys are two bean-shaped organs that filter waste and extra water out of your blood and turn it into urine. When they fail, that waste builds up in the body, which is dangerous and eventually life-threatening.

In a living donor transplant, the kidney comes from a person who is alive and healthy and chooses to give one of their two kidneys. Most people are born with two kidneys but can live a full, healthy life with just one, which is why this is possible. The other route is a deceased donor transplant, where the kidney comes from someone who has recently died and chosen (or whose family has agreed) to donate.

Living donation has real advantages. The kidney does not have to travel far or sit waiting, so it is usually in better condition. The surgery can be planned in advance instead of happening as an emergency. And on average a living donor kidney lasts longer and is less likely to be rejected by the body. Importantly, a transplant is not a cure for kidney disease. It is a treatment that, when it works well, frees a person from dialysis and lets them live a much more normal life.

A transplant may be considered when someone has end-stage kidney failure (kidneys working at a very low level) or chronic kidney disease that is heading that way. Many transplant centres will assess you when your kidney function (measured as GFR, or glomerular filtration rate) drops to around 20 or below, even before you have started dialysis. Having a transplant before starting dialysis is called a preemptive transplant, and research suggests outcomes are often better this way.

Good candidates are generally healthy enough to cope with major surgery and with the lifelong medicines that follow, have a clear understanding of the aftercare, and have support at home. There is usually no strict upper age limit; older adults and people with conditions such as diabetes often have successful transplants.

A transplant may not be advisable for someone with:

• A serious active infection (such as untreated tuberculosis) or a recent cancer that needs treatment first
• Severe heart, lung or liver disease that makes surgery too risky
• An inability to take daily anti-rejection medicines reliably for life
• Active, untreated substance misuse or some unmanaged mental-health conditions
• A very limited life expectancy for other reasons

Many of these are temporary or treatable. The point of the evaluation is to find out whether a transplant is likely to help you and to keep you safe, not simply to say yes or no.

The basic operation is similar in every case, but there are a few different situations:

• Standard living donor transplant. A relative, partner or friend who is a good match donates a kidney directly to you.
• Paired (kidney swap) exchange. If a willing donor is not compatible with their intended recipient, two or more pairs can swap, so each person receives a kidney that matches them. This avoids the extra hurdles of an incompatible transplant.
• Blood-group (ABO) incompatible transplant. With special preparation to reduce the antibodies in your blood, a transplant can sometimes go ahead even when the donor's blood type does not normally match.

On the donor side, the kidney is almost always removed using keyhole (laparoscopic) surgery, sometimes robot-assisted. The surgeon works through a few small cuts and one slightly larger one to lift the kidney out. This is far gentler than the old open operation and allows a faster recovery. Before any of this, the donor goes through thorough medical and psychological checks to confirm that giving a kidney is safe for them.

Both the donor and the recipient have their operations under general anaesthesia, meaning you are completely asleep and feel nothing. When the donor is living, the two operations are usually timed together so the kidney moves from one person to the other quickly.

For the person receiving the kidney, the surgeon makes a cut in the lower part of the abdomen, near the groin. Here is the part that surprises many people: your own failed kidneys are usually left in place. They are only removed if they are causing problems (for example, repeated infections or in some cases of polycystic kidney disease). The new kidney is placed lower down, in the pelvis. The surgeon connects the new kidney's artery and vein (its blood supply) to blood vessels in your pelvis, then connects its ureter (the tube that carries urine) to your bladder.

The recipient operation typically takes about 3 hours. If a pancreas transplant is being done at the same time for someone with diabetes, it can take around 6 hours. The donor's keyhole operation usually takes roughly 2-3 hours. Once the new kidney is connected, it may start making urine straight away, or it may take a few days or weeks to fully wake up, in which case temporary dialysis bridges the gap.

In hospital. Recipients usually stay in hospital for about 3 to 7 days. You will be monitored closely, with blood tests to check how the new kidney is working. A thin tube called a stent is often left between the kidney and bladder for a few weeks and removed later in a minor procedure. The surgical scar is usually a few centimetres long on the lower side of the abdomen.

The first weeks at home. Expect to feel tired and to need rest. Most people are advised to avoid heavy lifting for at least 6-8 weeks and not to drive for several weeks. In the first 1 to 3 months you will have frequent clinic visits and blood tests, so it helps to stay close to your transplant centre during this period.

Getting back to normal. Many people feel reasonably well within about 6 weeks and return to work within a few months, though full recovery can take up to about 6 months. Living donors recover faster: a hospital stay of 1-2 nights is common, with most donors back to normal activities within 4 to 6 weeks.

Throughout recovery you will take anti-rejection medicines exactly on schedule, drink the fluids your team recommends, and learn to watch for warning signs (covered below). Sticking to your medicine routine is the single most important thing you can do to protect the new kidney.

A kidney transplant is major surgery, and no operation is risk-free. Possible problems include:

• Surgical risks: bleeding, infection of the wound, and rarely heart attack, stroke or blood clots in the legs or lungs.
• Rejection: your immune system may recognise the new kidney as foreign and attack it. Early rejection often causes no symptoms and is picked up by routine blood tests, which is why monitoring matters. Possible signs include reduced urine, swelling, fever, tenderness over the kidney, or rising blood pressure. Many rejection episodes can be treated if caught early.
• Side effects of anti-rejection medicines: because these drugs dampen the immune system, you are more prone to infections and, over the long term, to certain cancers. Some can also contribute to high blood pressure, diabetes, bone thinning, cataracts and other effects, which your team monitors and manages.

For the donor, the operation carries the usual surgical risks, but serious complications are uncommon. The remaining kidney enlarges slightly and takes over the work. Studies show fewer than 1 in 100 donors later develop kidney failure, and donors have only a slightly higher long-term risk of kidney problems than non-donors. Donors are advised to have an annual check of blood pressure, urine and kidney function.

For most people, a successful transplant means more energy, fewer dietary and fluid restrictions, freedom from dialysis, and a better quality of life. Survival figures are encouraging: roughly 95% of transplanted kidneys are working at one year, and about 90% at three to five years.

A transplant does not last forever. On average, a kidney from a living donor lasts around 15 to 20 years, while a kidney from a deceased donor lasts about 8 to 12 years, though individual results vary widely. Some kidneys keep working far longer; some fail sooner. Encouragingly, large studies show living-donor kidneys have been lasting longer over time as care has improved. If a transplant eventually fails, it is usually possible to return to dialysis and, for many people, to consider another transplant later.

How long your kidney lasts depends partly on factors you can influence: taking your medicines faithfully, keeping blood pressure and blood sugar controlled, attending follow-up appointments, and avoiding smoking.

The cost of a living donor kidney transplant varies a great deal from country to country and clinic to clinic, so it is best to ask any clinic for a written, itemised quote rather than rely on a single headline figure. What you are quoted should make clear exactly what is and is not included.

The main things that change the price are:

• What the package covers: the donor's surgery and care, the recipient's surgery, hospital stay, surgeon and anaesthetist fees, and tests are sometimes bundled and sometimes charged separately.
• Pre-transplant work-up: the detailed matching tests, scans and specialist reviews for both donor and recipient.
• Length of stay and any complications, which can extend hospital time and add costs.
• Medicines: anti-rejection drugs are needed for life, and the early supply may or may not be in the package.
• Follow-up and travel: repeat clinic visits, accommodation near the hospital for the first weeks, and interpreter or coordinator services.

Always confirm whether the quote includes the donor's full care, post-operative follow-up, and what happens (and who pays) if a complication arises.

Turkiye has become a well-known destination for organ transplantation. It has a large number of internationally accredited hospitals, experienced transplant teams with high annual volumes, and costs that are often lower than in many Western countries. Many Turkish transplant surgeons are members of international transplant societies and trained at leading centres abroad.

It is important to understand the rules. Turkish law allows living donation only between close relatives (up to the fourth degree of kinship) and spouses, and every living-donor case must be approved by a hospital ethics committee. Paying for an organ is illegal. In practice this means international patients are generally expected to bring their own medically and ethically approved living donor, usually a family member, rather than buy or be matched to a stranger's kidney.

To choose a safe clinic and surgeon, verify the following:

• Hospital accreditation, such as Joint Commission International (JCI). You can check accreditation status directly on the accrediting body's website.
• The surgeon's qualifications and experience in kidney transplantation specifically, and membership of recognised transplant societies.
• Ethics committee approval for your donor, in line with Turkish law, with clear documentation.
• A written treatment plan and quote, including who manages complications and long-term follow-up.
• How aftercare will be coordinated with doctors back home once you return.

Be cautious of anyone offering an organ for sale or promising to bypass donor rules. That is both illegal and dangerous.

Good preparation makes the whole process smoother. Before treatment you and your donor will complete a thorough evaluation: blood typing, tissue typing (HLA matching), and a crossmatch test where the donor's and recipient's blood are mixed in the lab to predict whether your immune system would accept the kidney. You will also have heart, lung and general health checks, and screening for infections.

To prepare, gather your full medical records, list all your medicines and allergies, stop smoking as early as possible, and follow any diet, dialysis or vaccination advice your team gives.

Helpful questions to ask at your consultation include:

• How many living donor kidney transplants does this team perform each year, and what are their outcomes?
• Is my donor a good match, and what tests confirm this?
• What anaesthetic and surgical technique will be used, and how long will each of us stay in hospital?
• What are the specific risks for me and for my donor?
• Exactly what does the quote include, and what happens if there is a complication?
• Which anti-rejection medicines will I take, what are the side effects, and how will I get ongoing supplies at home?
• How will follow-up be shared with my doctors in my home country?

After a transplant, aftercare is lifelong. You will take anti-rejection medicines every day on a strict schedule, attend regular blood tests and clinic appointments, protect yourself from infections, stay well hydrated, and keep blood pressure and blood sugar under control. Knowing the warning signs of rejection (less urine, swelling, fever, pain over the kidney, sudden weight gain) and reporting them quickly can save the kidney.

If you are travelling for treatment, plan to stay near the hospital for the first weeks, when monitoring is most intensive, rather than flying home straight after discharge. Flying too soon after abdominal surgery carries risks, including blood clots in the legs or lungs (deep vein thrombosis), which are more likely in the weeks after an operation and during long periods of sitting still. Most guidance suggests waiting at least a couple of weeks after abdominal surgery before flying, but a transplant is major surgery, so the safest approach is to fly only when your transplant team confirms it is safe for you personally.

When you are cleared to fly, reduce clot risk by staying hydrated, moving and walking regularly during the flight, and wearing compression stockings if advised. Carry your medicines in your hand luggage with a doctor's letter, bring your transplant centre's contact details, wear medical identification, and arrange follow-up with a kidney specialist at home before you leave. A reputable clinic and concierge service will help coordinate all of this.