Living Donor Transplant Abroad: Comprehensive Guide 2025

What Is Living Donor Transplant?

Living donor transplantation is a surgical procedure in which a healthy person voluntarily donates an organ or part of an organ to a patient in need. This remarkable act of generosity is possible because certain organs, specifically the kidney and liver, can be safely donated by a living person. Humans are born with two kidneys but can live a completely normal and healthy life with just one, making kidney donation the most common type of living organ donation. The liver has the extraordinary ability to regenerate, allowing a donor to give approximately 40 to 60 percent of their liver, which regrows to near-normal size in both the donor and the recipient within six to eight weeks. Living donor transplantation offers several critical advantages over deceased donor transplant, including better graft survival, immediate organ function, the ability to schedule surgery electively, and the elimination of waiting list uncertainty.

The outcomes of living donor transplantation are consistently superior to those of deceased donor transplant across all measures. Living donor kidney transplants have 10-year graft survival rates of approximately 80 percent, compared to 60 to 65 percent for deceased donor kidneys. Living donor liver transplants achieve outcomes comparable to deceased donor liver transplants while avoiding the uncertainties of organ allocation and the limitations of cold ischemia time during organ preservation and transport. These superior outcomes result from the optimal timing of surgery, the excellent quality of organs from healthy living donors, minimal ischemia time, and the ability to thoroughly evaluate and prepare both the donor and the recipient before the operation proceeds.

International centers in Turkey, India, and South Korea have developed world-leading living donor transplant programs that attract patients from around the globe. Turkey, in particular, has become a global hub for living donor liver transplantation, performing over 2,000 procedures annually with success rates exceeding 90 percent. Acıbadem Maslak Hospital and Memorial Şişli Hospital in Istanbul are at the forefront of this field, with surgical teams that have performed thousands of living donor procedures and developed innovative techniques that improve donor safety and recipient outcomes. The cost of living donor transplantation at these centers is 60 to 85 percent lower than in the United States, making this life-saving surgery accessible to patients who might otherwise be unable to afford treatment.

Types of Living Donor Transplant

Living donor kidney transplantation is the most commonly performed living donor procedure worldwide, accounting for over 30 percent of all kidney transplants in many countries and over 50 percent in some nations. The procedure involves removing one kidney from the donor, typically through a minimally invasive laparoscopic approach, and implanting it in the recipient's pelvis. The donor is left with one functioning kidney, which is sufficient for all normal bodily functions. Long-term studies involving tens of thousands of kidney donors have demonstrated that living kidney donation does not increase the risk of kidney failure, cardiovascular disease, or overall mortality in carefully selected donors. Modern laparoscopic donor nephrectomy requires only three to four small incisions, resulting in minimal scarring, reduced post-operative pain, and a recovery period of just two to four weeks for most donors.

Living donor liver transplantation is a more complex procedure that involves removing a portion of the donor's liver, typically the right lobe (approximately 60 percent) for adult-to-adult transplant or the left lobe or left lateral segment for adult-to-child transplant. The donor's remaining liver regenerates to approximately 80 to 90 percent of its original volume within six to eight weeks, and the transplanted portion in the recipient grows similarly. This procedure requires exceptional surgical skill and is best performed at high-volume centers with extensive experience. Acıbadem Maslak Hospital performs hundreds of living donor liver transplants annually, with donor complication rates that are among the lowest in the world, reflecting the surgical team's expertise and the hospital's commitment to donor safety.

Paired and chain kidney donation programs have dramatically expanded living donor transplant opportunities for patients whose willing donors are not compatible. In a paired exchange, two donor-recipient pairs who are incompatible within their own pair swap donors, creating two compatible transplant combinations. Chain donations extend this concept further, with an altruistic donor initiating a chain of transplants that can benefit multiple incompatible pairs. Advanced protocols for ABO-incompatible and positive-crossmatch transplantation at centers like Acıbadem Altunizade Hospital further expand options, using desensitization techniques to overcome immunological barriers that would previously have prevented transplantation. These innovations mean that virtually every patient with a willing donor has a pathway to transplantation, regardless of blood type or antibody compatibility.

• Living donor kidney — laparoscopic nephrectomy, minimal recovery, excellent long-term safety
• Living donor liver (right lobe) — adult-to-adult, 60% of liver donated, regenerates in 6-8 weeks
• Living donor liver (left lateral) — adult-to-child, 15-20% of liver, ideal for pediatric recipients
• Paired kidney exchange — incompatible pairs swap donors for compatible matches
• ABO-incompatible donation — desensitization protocols overcome blood type barriers
• Positive crossmatch transplant — desensitization for antibody-incompatible donors
• Domino liver transplant — cascading transplants maximizing organ utilization

Donor Evaluation Process

The living donor evaluation is a rigorous and comprehensive process designed to ensure the donor's safety above all else. The evaluation begins with an initial screening that includes blood typing, basic blood tests, and a preliminary medical history review to identify any obvious contraindications to donation. If the initial screening is favorable, the donor proceeds to a comprehensive evaluation that includes a thorough physical examination, detailed blood work including kidney function tests, liver function tests, viral serology, coagulation studies, and metabolic panels, and advanced imaging to assess the anatomy and function of the organ to be donated.

For kidney donors, imaging typically includes a CT angiogram of the abdomen and pelvis, which provides detailed visualization of the kidney anatomy, blood vessel configuration, and urinary tract structure. For liver donors, a CT volumetry scan measures the liver volume precisely to ensure that both the donated portion and the remaining liver will be sufficient for adequate function. MRI cholangiography maps the bile duct anatomy, and liver biopsy may be performed if there is any concern about underlying liver disease. At centers like Memorial Şişli Hospital, the donor evaluation team includes transplant surgeons, nephrologists or hepatologists, radiologists, psychologists, and independent donor advocates who ensure that the donor's decision is fully informed and voluntary.

Psychological evaluation is a mandatory component of the living donor assessment, conducted by a mental health professional who is independent of the transplant team. The evaluator assesses the donor's motivations for donation, understanding of the risks and benefits, ability to give informed consent, emotional stability, and any evidence of coercion or financial incentive. This evaluation is particularly important for international patients, where cultural factors, family dynamics, and the desperation of the patient's condition may create subtle pressures on potential donors. Reputable transplant centers maintain strict ethical standards and will decline to proceed with donation if there is any concern about the donor's voluntariness, understanding, or suitability.

Ethics & International Regulations

The ethics of living donor transplantation, particularly in the international context, are of paramount importance and are governed by strict international guidelines and national laws. The World Health Organization's Guiding Principles on Human Cell, Tissue, and Organ Transplantation establish the fundamental ethical framework, which includes the prohibition of organ commercialism, the requirement for free and informed consent, the prioritization of donor safety, and the responsibility of healthcare systems to ensure equitable access to transplantation. The Istanbul Declaration on Organ Trafficking and Transplant Tourism, endorsed by over 130 countries, further reinforces these principles and calls for the development of self-sufficient national transplant programs to reduce the need for transplant tourism.

Turkey has established one of the most comprehensive legal frameworks for living donor transplantation in the world. Turkish law permits living organ donation only between close relatives (up to the fourth degree of kinship) and spouses, with strict oversight by hospital ethics committees and government authorities. Each living donor case must be approved by a multidisciplinary ethics committee that verifies the familial relationship, confirms the voluntariness of the donation, and ensures that no financial transaction is involved. These protections make Turkey one of the safest and most ethically transparent destinations for living donor transplantation, as the rigorous oversight eliminates the risks of organ trafficking and exploitation that have unfortunately been associated with transplant tourism in some other regions.

Patients considering living donor transplant abroad should verify that the chosen center adheres to international ethical standards and national regulations. Red flags include any mention of commercial organ purchase, centers that accept unrelated donors without strict justification and ethics committee approval, lack of independent donor advocacy, and pressure to proceed quickly without thorough evaluation. Reputable centers like Acıbadem Maslak Hospital and Memorial Şişli Hospital welcome questions about their ethical practices and are transparent about their donor evaluation processes, ethics committee procedures, and regulatory compliance.

Surgical Techniques & Innovation

Modern living donor surgery has benefited enormously from minimally invasive techniques that reduce donor discomfort, scarring, and recovery time. Laparoscopic donor nephrectomy, performed through three to four small incisions using a camera and specialized instruments, has become the standard approach for living kidney donation worldwide. The kidney is dissected free from its attachments, the blood vessels are divided using vascular staplers, and the kidney is extracted through a small incision that is expanded just enough to remove the organ. This approach results in less pain, shorter hospital stays (typically one to three days), faster return to activities, and better cosmetic outcomes compared to traditional open surgery.

Robotic-assisted donor nephrectomy represents the latest advancement in living donor kidney surgery, offering enhanced three-dimensional visualization, greater instrument dexterity, and improved ergonomics for the surgeon compared to standard laparoscopy. The robotic platform allows for precise dissection around the kidney vessels and ureter, potentially reducing the risk of vascular injury and ureteral complications. For living donor liver transplantation, minimally invasive approaches are emerging but remain technically challenging due to the complexity of liver anatomy and the need for precise hepatic vein and bile duct division. Some leading centers have begun performing laparoscopic or robotic-assisted donor hepatectomy for left lateral segment donations in adult-to-child transplants, though open surgery through a subcostal incision remains the standard for right lobe adult-to-adult donations.

At centers like Acıbadem Maslak Hospital, the living donor surgical team utilizes intraoperative imaging including contrast-enhanced ultrasound and indocyanine green fluorescence angiography to verify vascular anatomy and ensure complete hemostasis before closure. Three-dimensional CT reconstruction is used for preoperative surgical planning, allowing the team to map the precise vascular and biliary anatomy of each donor's liver and plan the transection line accordingly. These advanced techniques minimize the risk of complications and optimize the quality of the donated organ. Continuous advancements in surgical technology and technique have made living donor surgery remarkably safe, with donor mortality rates below 0.03 percent for kidney donation and 0.2 to 0.5 percent for liver donation at high-volume centers.

Donor Recovery & Safety

Living kidney donors typically spend one to three days in the hospital after laparoscopic nephrectomy. Post-operative pain is managed effectively with oral analgesics, and most donors are walking independently within hours of surgery. Most donors return to desk-based work within two weeks and to physically demanding jobs within four to six weeks. Long-term studies following kidney donors for 20 to 30 years have consistently demonstrated that carefully selected donors have no increased risk of kidney failure, cardiovascular disease, or premature death compared to the general population. The remaining kidney undergoes compensatory hypertrophy, growing slightly larger and increasing its filtration capacity by 30 to 40 percent, which is sufficient for all normal kidney functions throughout the donor's lifetime.

Living liver donors require a somewhat longer recovery due to the greater extent of the surgery. Hospital stays typically range from five to ten days, and most donors return to normal activities within six to eight weeks. The donor's remaining liver begins regenerating immediately after surgery and reaches approximately 80 to 90 percent of its original volume within six to eight weeks. Liver function tests may be transiently elevated after surgery but return to normal within two to four weeks in most cases. Complications requiring intervention occur in approximately 10 to 15 percent of liver donors, primarily related to bile leaks, wound infections, or temporary fluid collections, all of which are generally manageable with conservative treatment or minimally invasive procedures.

Centers like Acıbadem Maslak Hospital provide comprehensive follow-up protocols for living donors that include regular blood tests, imaging studies, and clinical assessments at defined intervals following donation. Donor well-being is monitored not only in terms of physical recovery but also psychological adjustment, as some donors may experience emotional reactions related to the donation process. The hospital maintains lifelong follow-up records for all living donors and provides ongoing support through dedicated donor coordinator services. This commitment to donor safety and long-term monitoring reflects the ethical responsibility that leading transplant centers take toward the individuals who make living donor transplantation possible.

Donating part of my liver to save my daughter was the most natural decision I ever made. The surgical team in Istanbul made me feel completely safe throughout the process. My liver has fully regenerated and my daughter is thriving with her new liver.

Fatih K., living liver donor from the Netherlands

Frequently Asked Questions