Multi-Organ Transplant Abroad: Complex Cases Guide 2025

Multi-Organ Transplant Overview

Multi-organ transplantation represents the pinnacle of surgical complexity and medical achievement, involving the simultaneous or sequential replacement of two or more organs in a single patient. These procedures are performed when disease or dysfunction affects multiple organ systems simultaneously, making isolated single-organ transplant insufficient to address the patient's needs. The most common multi-organ transplant is the simultaneous pancreas-kidney transplant, performed for Type 1 diabetic patients with end-stage kidney disease, but combined liver-kidney, heart-lung, heart-kidney, and multi-visceral transplants are also performed at specialized centers worldwide. These procedures require extraordinary surgical expertise, meticulous coordination between multiple surgical teams, extended operating times that can reach 12 to 18 hours, and intensive post-operative care.

The development of multi-organ transplantation over the past three decades has expanded the boundaries of what is possible in medicine, offering hope to patients with complex conditions who previously had no treatment options. Advances in surgical technique, organ preservation, immunosuppressive therapy, and peri-operative care have made these procedures safer and more effective than ever before, though they remain among the most challenging and resource-intensive operations in medicine. The success of multi-organ transplantation depends critically on the experience and capabilities of the transplant center, as these procedures require not only exceptional surgical skill but also a comprehensive infrastructure including multiple surgical teams, advanced operating theaters, specialized ICU capabilities, and coordinated post-operative care protocols.

The cost of multi-organ transplantation in the United States is staggering, ranging from $350,000 for simultaneous pancreas-kidney transplant to over $2.5 million for multi-visceral transplant. These costs reflect the extraordinary complexity of the procedures, the involvement of multiple surgical teams, extended operating room time, prolonged ICU stays, and the intensive post-operative management required. International centers in Turkey and India offer significant cost savings while maintaining the surgical expertise and infrastructure needed for these complex procedures. Acıbadem Maslak Hospital has performed multi-organ transplants including combined liver-kidney and simultaneous pancreas-kidney procedures, with experienced surgical teams and comprehensive post-operative care capabilities that support optimal outcomes for these challenging cases.

Types of Multi-Organ Transplant

Simultaneous pancreas-kidney transplantation is the most frequently performed multi-organ transplant, with approximately 800 procedures performed annually in the United States alone. This combined procedure addresses both the diabetes and the diabetic kidney disease in a single operation, providing the patient with insulin independence and freedom from dialysis simultaneously. The pancreas and kidney are typically obtained from the same deceased donor, ensuring optimal immunological matching, and the surgery is performed through a single abdominal incision. SPK transplant achieves the best outcomes of all pancreas transplant categories, with one-year pancreas graft survival of 85 to 90 percent and one-year kidney graft survival exceeding 95 percent at experienced centers.

Combined liver-kidney transplantation is performed for patients with simultaneous liver and kidney failure, which can result from conditions such as polycystic liver and kidney disease, primary hyperoxaluria, hepatorenal syndrome, or concurrent hepatitis C with glomerulonephritis. The procedure typically involves sequential transplantation of the liver followed by the kidney during the same operation, with the liver transplant performed first because the liver graft can provide immunological tolerance that benefits the subsequently transplanted kidney. At centers like Memorial Şişli Hospital, the combined liver-kidney transplant team includes hepatobiliary surgeons, transplant nephrologists, and vascular surgeons who work together to manage the complex surgical and medical aspects of these procedures.

Combined heart-lung transplantation is reserved for the most critically ill patients with irreversible failure of both the heart and lungs, most commonly due to Eisenmenger syndrome associated with congenital heart disease, severe pulmonary arterial hypertension with right heart failure, or cystic fibrosis with concurrent cardiomyopathy. This procedure is technically demanding and relatively rare, with fewer than 70 performed worldwide each year. Multi-visceral transplantation, which involves replacing multiple abdominal organs including the stomach, small intestine, pancreas, and sometimes the liver, represents the most complex transplant procedure in existence and is performed for patients with intestinal failure combined with loss of venous access for parenteral nutrition and concurrent liver disease.

• SPK — simultaneous pancreas-kidney for Type 1 diabetes with kidney failure
• Liver-kidney — combined transplant for concurrent hepatic and renal failure
• Heart-lung — combined for Eisenmenger syndrome and severe PAH with RV failure
• Heart-kidney — for concurrent heart and kidney failure
• Liver-intestine — for intestinal failure with liver disease
• Multi-visceral — stomach, intestine, pancreas, +/- liver replacement
• Modified multi-visceral — preservation of native stomach with intestine-liver transplant

Cost Comparison for Multi-Organ Transplants

Multi-Organ Transplant Cost Comparison 2025

K = Thousand, M = Million. Multi-organ costs are higher due to longer surgery, extended ICU, and complexity. Prices are approximate and depend on case complexity.

The cost savings for multi-organ transplantation abroad can be even more dramatic than for single-organ procedures, given the extremely high baseline costs in the United States. SPK transplant at Acıbadem Maslak Hospital costs $80,000 to $140,000 compared to $350,000 to $550,000 in the US, representing savings of 70 to 80 percent. Combined liver-kidney transplant is available for $120,000 to $200,000 in Turkey compared to $600,000 to $900,000 in the US. These savings are possible because the cost structure in Turkey, including surgeon fees, operating room charges, ICU rates, and medication costs, is fundamentally lower than in the United States without any compromise in the quality of care delivered.

Patients considering multi-organ transplant abroad should be aware that these procedures require the most experienced and capable centers, and not all international transplant hospitals have the expertise and infrastructure to perform every type of multi-organ transplant. When evaluating potential centers, prioritize those with documented experience in the specific combination of organs you need, with published outcome data, and with the multidisciplinary team structure needed to manage the complex peri-operative and post-operative care. Acıbadem Maslak Hospital and Memorial Şişli Hospital in Istanbul have the capabilities for most multi-organ combinations, while more complex procedures like multi-visceral transplantation are available at a limited number of highly specialized international centers.

Specialized Centers for Multi-Organ Transplant

Acıbadem Maslak Hospital stands as one of the region's most capable multi-organ transplant centers, with surgical teams experienced in simultaneous pancreas-kidney, combined liver-kidney, and other complex multi-organ procedures. The hospital's infrastructure supports these demanding operations with multiple advanced operating theaters that can accommodate extended surgeries, dedicated transplant ICUs with continuous hemodynamic monitoring and organ-specific management protocols, and comprehensive laboratory capabilities for real-time intraoperative monitoring. The transplant coordination team ensures seamless communication between surgical teams, anesthesiologists, and intensive care specialists throughout these marathon procedures.

Memorial Şişli Hospital complements the multi-organ transplant landscape in Turkey with particular strength in hepatobiliary surgery and combined liver transplant procedures. The hospital's hepatology department has extensive experience managing complex cases of liver failure combined with kidney disease, and the surgical team has developed expertise in the sequential approach to combined liver-kidney transplantation that optimizes outcomes for both grafts. Anadolu Medical Center, with its Johns Hopkins partnership, brings American-standard protocols to multi-organ transplantation, ensuring adherence to evidence-based guidelines and rigorous quality metrics.

Candidacy & Evaluation for Multi-Organ Transplant

The evaluation process for multi-organ transplant candidacy is the most comprehensive and rigorous of any transplant evaluation, reflecting the complexity and risk of these procedures. Each organ system to be transplanted requires its own complete evaluation by the respective specialty team, and the overall assessment must determine that the patient is fit enough to survive and recover from what is often a very long and complex surgical procedure. For SPK candidates, both the endocrinology team and the nephrology team conduct independent evaluations. For combined liver-kidney candidates, hepatologists and nephrologists collaborate to assess the severity and trajectory of both organ failures and determine whether combined transplant is necessary or whether sequential transplantation might be more appropriate.

Cardiovascular fitness is especially critical for multi-organ transplant candidates, as these procedures involve prolonged operating times, significant hemodynamic stress, and extended periods of anesthesia. Comprehensive cardiac evaluation including echocardiography, stress testing, and in many cases cardiac catheterization is mandatory for all multi-organ transplant candidates. Nutritional status assessment and optimization are also important, as malnourished patients have significantly higher complication rates and poorer outcomes after complex surgery. Psychological evaluation assesses the patient's understanding of the procedure's complexity, their support system, and their capacity to manage the demanding post-operative medication and follow-up regimen that multi-organ transplantation requires.

Recovery & Outcomes

Recovery from multi-organ transplantation is inherently more complex and prolonged than recovery from single-organ transplant, reflecting the greater surgical stress and the need to monitor and manage multiple transplanted organs simultaneously. ICU stays are typically longer, ranging from one to three weeks depending on the procedure type and the patient's recovery trajectory. Total hospital stays of three to six weeks are common, during which multiple surgical teams monitor their respective grafts, immunosuppressive therapy is carefully calibrated to protect all transplanted organs, and the patient gradually progresses through mobilization and rehabilitation milestones. The nursing staff in multi-organ transplant units requires specialized training to monitor the complex interplay between multiple organ systems and their medications.

Long-term outcomes for multi-organ transplantation have improved considerably over the past two decades. SPK transplant, as the most commonly performed combination, achieves the best outcomes with patient survival exceeding 95 percent at one year and 85 percent at five years. Combined liver-kidney transplant outcomes are also favorable, with one-year patient survival of approximately 85 to 90 percent and five-year survival of 70 to 80 percent. Heart-lung transplant outcomes are more modest, with median survival of approximately seven to eight years, reflecting the inherent challenges of maintaining two of the body's most vital organs in the setting of chronic immunosuppression. Multi-visceral transplant outcomes have improved substantially but remain lower than other combinations, with five-year survival of approximately 50 to 60 percent at the most experienced centers.

At centers like Acıbadem Maslak Hospital, patients undergoing multi-organ transplant benefit from a coordinated multidisciplinary approach to recovery that ensures all transplanted organs receive appropriate attention and monitoring. The hospital's international patient department provides additional support for families who are far from home during what is often a lengthy and emotionally intense process. Follow-up protocols are carefully designed to monitor all transplanted organs through regular blood tests, imaging studies, and biopsies as needed, with clear criteria for escalation and intervention if any graft shows signs of dysfunction or rejection.

My simultaneous pancreas-kidney transplant ended my 25-year battle with Type 1 diabetes and freed me from dialysis in a single operation. The surgical team in Istanbul handled this complex procedure with incredible skill and coordination. It truly changed my life.

Thomas M., SPK transplant recipient from Belgium

Frequently Asked Questions