The Pediatric Organ Transplant Process and the Vital Importance of Donation

Organ transplantation in children is the most effective life-saving medical intervention for those whose vital organs have been irreversibly damaged. While hundreds of children in Türkiye are placed on waiting lists for a new heart, liver, or kidney every year, increasing pediatric organ donation rates remains the only beacon of hope for these tiny patients. Pediatric transplantation processes require much more delicate surgical techniques and specialized post-operative care compared to adults.

In Brief:

• Kidney, liver, and heart transplants are the most frequently performed procedures in children.
• Organs can be obtained from living donors (usually family members) or individuals who have been declared brain dead (deceased donors).
• Because pediatric patients have smaller blood vessels and body sizes, they generally need donations from their own age and weight groups.
• Lifelong immunosuppressive medications are used to prevent organ rejection after the transplant.
• With a successful surgery and regular follow-up, children can return to their education, playtime, and normal growth processes.

What is Pediatric Organ Transplantation?

Pediatric transplantation is the surgical replacement of an organ that has completely lost its function due to congenital anomalies, genetic diseases, or severe acquired infections with a healthy organ. This process is not simply a scaled-down version of adult surgery; the millimeter-sized diameters of children's blood vessels, their developing immune systems, and their growth potential make the procedure highly specific.

For end-stage organ failure where no other treatment is possible, transplantation is the only permanent solution. The procedure can be performed using an organ from a living donor (such as a portion of a liver or a single kidney from a mother or father) or from a deceased donor who has been declared brain dead. Since there is no living donor option for organs like the heart, deceased donations are of vital importance. The survival of children on organ waiting lists is directly linked to increasing public awareness about donation. A successful transplant performed early on allows the child's physical and mental development to catch up with their peers.

Causes and Risk Factors of Organ Failure in Children

The causes of organ failure in childhood are quite different from those in adults. While diabetes, hypertension, or lifestyle-related diseases are prominent in adults, congenital anomalies and inherited genetic diseases are typically the main factors in children. The most common cause of liver failure is "biliary atresia," a condition where the bile ducts are congenitally blocked or absent. Additionally, metabolic disorders like Wilson's disease or sudden poisonings can also lead to acute liver failure.

In cases of kidney failure, congenital kidney and urinary tract anomalies, cystic kidney diseases, and treatment-resistant nephrotic syndrome are among the most common causes. Heart failure generally develops as a result of congenital heart defects, valve problems, or cardiomyopathies that cause the heart muscle to weaken. Risk factors include consanguineous marriages, certain severe infections during pregnancy, and genetic predisposition. Early diagnosis of congenital problems allows for medical or surgical interventions that can delay complete organ failure.

Symptoms of Conditions Requiring an Organ Transplant

Symptoms of organ failure vary depending on the affected organ and the stage of the disease. In liver failure, noticeable yellowing of the whites of the eyes and skin (jaundice), swelling in the abdomen due to fluid accumulation (ascites), severe itching, and dark-colored urine are the most typical findings. Children developing kidney failure may experience swelling in the eyelids in the mornings, edema in the legs, a decrease in urine output, pale skin color, and high blood pressure that does not respond to treatment.

In heart failure, exercise capacity drops rapidly; babies tire easily and sweat while feeding, whereas older children experience shortness of breath even during short walks. The most common and insidious symptom of all these chronic organ failures is growth retardation. Because the body spends all its energy trying to survive, the child's weight gain and height growth come to a halt. During this process, underlying chronic diseases play a huge role among the causes of loss of appetite in children. Refusing to eat, a constant state of fatigue, and a reluctance to play are serious warning signs that families must take into account.

Conditions for Organ Donation and How the Transplant Process Works

When your child's doctor decides an organ transplant is necessary, the first step is registration on the Ministry of Health's National Organ Waiting List. At this stage, the conditions for organ donation come into play. To be a living donor in Türkiye, a person must be over 18 years of age, be of sound mind, and have a blood or marital relationship with the recipient up to the fourth degree. Furthermore, the donor's general health must be robust enough to withstand the surgery and the subsequent recovery process.

In deceased donor transplants, the families of patients diagnosed with brain death in the intensive care unit must give consent for donation. Once a suitable organ is found, blood type compatibility, tissue compatibility, and the size match of the organ (its ability to fit into the child's chest or abdominal cavity) are evaluated. Size matching is especially critical for young children; while only a small lobe of a liver taken from an adult can be transplanted into a child, in kidney transplants, an adult kidney is placed into the child's abdominal cavity using a special surgical technique. The process is carefully planned with detailed laboratory tests to ensure the immune system does not reject the organ.

Treatment: The Transplant Surgery and Recovery Process

When a suitable organ is found, a race against time begins. The transplant surgery is a highly delicate microsurgical procedure that lasts an average of 4 to 12 hours, depending on the type of organ. After the surgery, the child is monitored in the pediatric intensive care unit for anywhere from a few days to a few weeks to ensure the organ adapts to the body and blood flow is regular. During this critical period, ventilator support, fluid balance monitoring, and infection control are meticulously maintained.

Once the child is transferred from intensive care to the regular ward, the recovery process truly begins. To prevent the body from perceiving the new organ as a foreign substance and attacking it, treatment with immunosuppressive drugs is initiated. These medications must be used for life. After being discharged from the hospital, it is essential to ensure strict hygiene conditions at home and avoid crowded, enclosed spaces for a while. During the recovery process, the family's strict adherence to medication schedules, following the nutrition program provided by the dietitian, and attending regular outpatient check-ups are the most important factors determining the long-term success of the transplant.

Complications and Risk Groups

The two greatest risks encountered after an organ transplant are organ rejection and infections. Organ rejection occurs when the immune system perceives the new organ as foreign tissue. Acute rejection is usually seen within the first few months, while chronic rejection can develop slowly over years. With regular medication use and blood tests, rejection episodes can be detected early and brought under control by adjusting medication doses.

The immunosuppressive medications used lower the child's resistance to normal infections. A cold or diarrhea that might be mild for a healthy child can be severe enough to require hospitalization for a transplant recipient. Extra precautions should be taken, especially against outbreaks of gastrointestinal infections in children during autumn. Diarrhea or vomiting is highly risky because it can cause vital anti-rejection medications to be expelled from the body before being absorbed. The first six months post-transplant is the period when the risk of infection is highest, and wearing protective masks and practicing diligent hand hygiene are crucial during this time.

When to Visit the Emergency Department?

During the home care of a child who has undergone an organ transplant, certain symptoms require emergency medical intervention. Because your child's immune system is suppressed, infections can progress very rapidly. If you observe any of the following symptoms, you should call 112 (or your local emergency number) without delay or visit the emergency department of the nearest fully equipped hospital:

• A fever of 38°C (100.4°F) or higher measured from the armpit.
• Severe and repeated vomiting that prevents medications from being swallowed or kept down.
• Watery diarrhea occurring more than three times a day.
• Sudden yellowing of the whites of the eyes or skin, or urine darkening to the color of tea.
• Sudden redness, swelling, discharge at the surgical site, or pain so severe that the child will not allow the area to be touched.
• Difficulty breathing, bluish discoloration of the skin (cyanosis), confusion, or excessive drowsiness.

Since these symptoms can be harbingers of organ rejection or a serious blood circulation problem, you should immediately inform your physician rather than waiting at home and administering fever reducers.

The Process and Pediatric Surgery Support at BHT CLINIC

The monitoring and surgical processes of chronic organ failures in children require a multidisciplinary approach. At BHT CLINIC İstanbul Tema Hastanesi, the medical treatments of children progressing toward organ failure are meticulously managed by our expert pediatric staff. During the pre-transplant preparation phase, our Pediatric Surgery department is by your side with its experienced team for the insertion of dialysis catheters, biopsy procedures, or resolving accompanying issues such as inguinal hernias or undescended testicles.

In our department, many procedures ranging from neonatal surgery to pediatric urology are safely performed using minimally invasive (laparoscopic) methods, tailored to the delicate physiology of children. In the event of any surgical complication or emergency that may develop in the post-transplant period, we provide uninterrupted healthcare with our 24/7 emergency department and modern pediatric intensive care unit. At every step concerning your child's health, we stand by you in the safe environment of our hospital, which is equipped to international JCI quality standards.

Frequently Asked Questions

Who can donate pediatric organs?

Living donor donations are usually made by a mother, father, or relatives up to the fourth degree. Deceased donations take place with the consent of the family of an individual of any age whose brain death has been medically confirmed under intensive care conditions.

Is living-donor organ transplantation possible in children?

Yes, living-donor transplants are possible for liver and kidney procedures. A small portion of an adult relative's liver or one of their two kidneys can be removed and transplanted into the child; the donor's remaining organs are sufficient to sustain their own healthy life.

Can a child who has had an organ transplant lead a normal life?

With a successful transplant and regular follow-up, children can return to a completely normal life. They can go to school, play sports, and experience a healthy growth and puberty process just like their peers; however, it is essential that they take lifelong medication and pay strict attention to hygiene rules.

Which organs are most frequently transplanted in children?

Liver and kidney transplants are the most commonly performed during childhood. These are followed by heart transplants, and more rarely, lung and small intestine transplants.

Is there an age limit for organ donation?

There is no age limit for deceased organ donation; anyone from a newborn baby to an elderly adult who has been declared brain dead can be an organ donor. However, to be a living donor, one must legally be over 18 years of age.

You can book an appointment for your child's surgical evaluations and detailed examination, or contact us 24/7 via our call center at 0850 811 34 00.

This article is for informational purposes only; please consult your physician for diagnosis and treatment.