Liver transplant in Turkey: living donors, the law and the process

When a liver transplant is considered

A liver transplant is considered when the liver is so badly damaged that other treatments no longer help. In adults the commonest reasons are advanced cirrhosis after chronic hepatitis B or C, alcohol-related or metabolic (obesity-related) liver disease, autoimmune and cholestatic diseases and, within defined criteria, primary liver cancer (hepatocellular carcinoma). In children the most frequent cause is biliary atresia.

Whether a transplant is appropriate is judged by a hepatologist and a transplant surgeon, based on how severe the disease is (for example the MELD and Child-Pugh scores), general fitness and other conditions. For the wider picture, see our organ transplantation guide.

Why patients consider Türkiye

Türkiye has one of the largest experiences in the world with living-donor liver transplantation, because living donation has traditionally been the main source of organs there. The large private hospital groups in Istanbul run transplant programmes with intensive care units and international patient departments. Patients also mention short direct flights from Sofia, Varna and many European cities, and coordination in their own language.

It is essential to understand one thing: a transplant in Türkiye is not a route to a deceased-donor organ. It is possible only when a suitable living donor from the family travels with the patient.

The law in Türkiye: who can donate

Transplantation is governed by the Law on the Removal, Storage, Grafting and Transplantation of Organs and Tissues (Law No. 2238) and the regulations of the Turkish Ministry of Health. The main rules:

• the donor is an adult with full legal capacity and gives written, voluntary and informed consent;
• relatives up to the fourth degree and spouses may donate;
• any other donor needs approval from the transplant centre's ethics committee;
• the relationship must be proven with official documents, usually apostilled and with a certified translation;
• any payment, buying, selling or brokering of organs is a criminal offence;
• deceased-donor organs are allocated only through the Turkish national system.

These rules follow the Declaration of Istanbul and the Council of Europe Convention against Trafficking in Human Organs. Read more in organ donation: law and ethics.

How a living liver donor is assessed

Donating part of the liver is major surgery for a healthy person. The donor assessment therefore runs in stages and stops at the first sign of increased risk.

• Blood group – compatibility is usually required.
• Blood tests – liver and kidney function, clotting, viral hepatitis and other infections.
• Imaging – CT and/or MRI to measure liver volume, map the blood vessels and bile ducts and check for fatty liver.
• Graft volume – the part to be transplanted must be large enough for the recipient while the part left behind stays safe for the donor. A liver biopsy is sometimes needed.
• Psychological assessment and ethics committee – to confirm the decision is free of pressure or reward.

For an adult recipient the right lobe is most often used; for a child, a smaller left-sided segment. The donor can withdraw at any time. Nobody can legally "find" a donor for money – such an offer is a crime.

The process, step by step

1. Records review. You share discharge letters, blood tests, scans and any pathology reports. A hepatologist and a transplant surgeon judge whether a transplant is indicated and how urgent it is.
2. Written plan. You receive a description of the tests for patient and donor, the expected length of stay and the documents to prepare. New City Clinic, as the organiser, usually sends such a plan within 24 hours of reviewing the records.
3. Travel and assessment. Patient and donor arrive in Istanbul together for the pre-transplant evaluation and the ethics committee review.
4. Surgery. The donor and recipient operations take place at the same time and usually last many hours.
5. Intensive care and hospital stay. The recipient first goes to intensive care; the total hospital stay is usually a few weeks. The donor is usually discharged after about a week.
6. Check-ups in Istanbul and going home. Outpatient visits and medicine adjustments follow until the team judges travel to be safe. You receive a detailed discharge summary for your doctor at home.

Risks for recipient and donor

For the recipient, risks include bleeding, thrombosis of the hepatic artery or portal vein, bile duct complications (leaks or narrowing), infections, rejection and, rarely, poor graft function that may require a second transplant.

For the donor, the operation carries more risk than kidney donation. Bile leaks, bleeding, infection, thrombosis and temporarily reduced function of the remaining liver can occur. Serious complications are uncommon but not impossible, and they must be discussed openly with the team before consent is given. The donor's liver usually regrows much of its volume within a few months.

After the transplant, anti-rejection medicines are taken every day for life. See life after a transplant.

Choosing a hospital and team

Questions worth asking:

• Is the hospital authorised by the Turkish Ministry of Health for living-donor liver transplantation?
• How many living-donor liver transplants does the team perform each year, and who will operate on the donor and the recipient?
• How is the donor looked after if complications appear after returning home?
• What follow-up is planned, and how will it be coordinated with your hepatologist at home?

New City Clinic organises treatment at the Acıbadem, Medicana, Medipol and Medical Park hospital groups and Biruni University Hospital – see partner hospitals. The suitable centre is chosen after the records review, and medical and ethical approval remain entirely with the transplant centre.

Preparation, follow-up and insurance

Good preparation reduces delays and stress for the family:

• gather the patient's full records – discharge letters, recent blood tests, abdominal CT or MRI on a disc, endoscopy reports;
• prepare the donor's proof of relationship in good time, apostilled and translated if the hospital requires it;
• plan for a companion who can stay for the whole period – after surgery both patient and donor need help;
• arrange a hotel near the hospital for the weeks after discharge, when check-ups are frequent;
• bring a list of all current medicines and any allergies.

If the patient is very unwell, the team may decide that travel is not safe; that decision is made together with the treating hepatologist.

Follow-up at home and insurance

Before travelling, agree which hepatologist or transplant centre at home will follow you up and how you will obtain your medicines. The donor also needs a plan for check-ups.

The EU Cross-Border Healthcare Directive (2011/24/EU) and the S2 form cover treatment within the EU and EEA. Türkiye is not an EU member, so these routes generally do not apply. Ask your national health insurer in advance what will be covered after you return.

When to see a doctor

Ask to see a hepatologist about transplantation if you have cirrhosis with complications – fluid in the abdomen (ascites), bleeding from swollen veins in the gullet, confusion (hepatic encephalopathy) or jaundice. After a transplant, contact the team immediately if you have a temperature above 38 °C, yellowing of the skin or eyes, dark urine or pale stools, abdominal pain, or you cannot take your medicines.

For how treatment is organised, see Treatment in Türkiye.