It is impossible to examine the development of transplant methods completely in a single article. However, I think it will be useful to review the history of organ transplantation, which is defined as an important development of medicine in the 21st century. The first chapter of such a study approaches the method of transplantation from different aspects in the world and Turkey.

The organ transplant method, which is one of the most complicated and problematic fields of modern surgery, has maintained its actuality since the prehistoric ages and has become one of the focal points of scientists. Within the literature of modern medicine, it is noted that the first kidney transplant operation was performed by the Hungarian surgeon Dr. Ullman in Wien in 1902 on animals.¹ In the same year, the young French surgeon Alexis Carrell published an article with the title “Suture of Blood Vessels and Transplantation of Organs” in Lyon, and he was entitled to receive a Nobel Prize in 1912 with this article.²

At the beginning of this century, studies were conducted on the immunological nature of tissues and organ transplant. Sir Peter Medawar contributed to create a suitable ground for transplantation with his skin graft study he conducted in 1943 and then with his study he conducted in 1953 related to the immunological tolerance gain.³

The modern era for kidney transplant on humans started with the kidney transplant from a deceased donor conducted in 1933 in Russia by Voronoy4 whose results were published in a not well-known journal in 1936. A series of kidney transplant operations was conducted by Hume, Merrill, Miller and Thorn5 in Boston in 1950, 1953, and 1955. Thus, a new process was initiated for clinical research in this field. With those studies, basic immunologic comprehension was started to be considered together with the clinical productivity of the organ transplant method, and then the first successful kidney transplant operation was conducted through relatives (maternal twins) by Murray and associates in Boston and by Hamburger and associates in Paris in 1954 for the first time.^6,7 In 1958 and 1959, another kidney transplant operation was conducted again in Boston and Paris through relatives (but not maternal twins) by not using the whole body irradiation as immunosuppressant.^7,8 The longest living patient after this operation was reported as 22 months by Dr. Hamburger and associates.⁹

The difficulties compared with whole-body irradiation as an immunosuppressive modality were extremely great. This issue required more practical immunosuppressive methods. In 1958 and 1959, Schwartz and Damshek published their study indicating immunological tolerance inhibition with druginduced through “antimetabolite 6-mercaptop­urine” and antibody production.¹⁰ The possibility to direct the immune response through drugs for kidney transplantation was identified by 2 inde­pendent surgical teams. In 1960, Professor Roy Calne¹¹ who was working in London and Boston and Dr. Zukowski12 from Richmond reported extended survival as a result of a kidney transplant operation conducted on a dog through 6-mercap­topurine. Dr. Hitching from Burroughs Welcome developed a derivative for 6-mercaptopurine that was less toxic and would be later called azathioprine (Imuran). Dr. Hitching and Dr. Elion were awarded with a Nobel Prize thanks to their contributions including changing this drug.¹³

Thanks to this immunosuppressive method, a new era began for organ transplant and Hume reported the results of 31 non-twin human renal homotransplants in 1964.¹⁴

In 1965, Starzl published¹⁵ his experiences on kidney transplantation, including leukocyte antigen adaptation; in the same year, Reemtsma reported the long life of a patient after xenograft (chimpanzee kidney) to a human recipient.¹⁶ The collaboration developed through a basic laboratory research, and clinical surgery made way for new clinical fields called “surgical biology” or “immunologist surgery”.17 In 1967, while Starzl reported the results of the successful liver transplantation on children,¹⁸ Christian Bernard performed the first cardiac transplantation on humans.¹⁹

With these surgical developments, immune-biological studies became more urgent, and the concept of “brain death” was started to be discussed with the issue of organ donation.20,21 The study of Belzer on “continuous pulsatile perfusion machine” accelerated organ preservation in 1972.^22,23 Following those studies, there were successive kidney transplant operations from several countries.^8,24

Twenty-one years after the first successful living related kidney transplant in the world, the first kidney transplant through relatives was conducted on November 3, 1975 for a 12-year-old male patient from his mother in Turkey by our team (Figure 1).²⁵ At that time, no legislation was in existence regarding transplantation; therefore, any transplan­tation that was performed was simply conducted with the written consent of the donor and the recipient. Also, the only option for transplant candidates on waiting lists in Turkey was to receive a graft from a first-degree living-related donor. Again, there were plenty of patients but not enough organs.²⁶

Our next goal was to perform deceased-donor kidney transplantation at our center and in Turkey. I realized that it was very important for us to show the public that kidneys from a deceased-donor would give patients with chronic kidney disease a new life. As there was no organ transplantation law in Turkey at the time, I had to apply to Eurotransplant International Foundation in Leiden, Netherlands. Finally on October 10, 1978, we received an organ supplied by Eurotransplant International Foundation within a vacuumed bottle and container (Figure 2A). Back then, no one was using deceased kidneys older than 12 hours cold ischemic time. The ones we received had a cold ischemia time of over 24 hours. After making necessary tests, we found that it was a healthy kidney and the cross match was negative. We performed a successful operation, and the kidney transplant functioned very well. This was the first successful deceased-donor kidney transplant in Turkey.^27,64,65

In fact, this was a major achievement; in addition to Eurotransplant Foundation, I contacted the Southern Eastern Organ Procurement Foundation (SEOPF) in the Unites States and started to receive kidneys from them also (Figure 2B).

We proved that kidneys could be transplanted successfully with an increased cold ischemia time of more than 100 hours (Figures 2C and D). At that time, I had presented a paper on this subject during the first ESOT Congress in Zurich, in 1983, which was followed by other internationally published articles.^28,29

I started to work with the government authorities, with the Board of Religious Affairs, charity organizations, such as the Lions and Rotarians, and various groups in mass media trying to raise public awareness on deceased-donor transplantation and organ donation and the related challenges that face health professionals. I began to make guest appearances on television and radio programs together with my transplant patients. We tried to create public awareness on transplantation, organ donation, and its necessity. Meanwhile, I decided to establish the Turkish Dialysis and Transplantation Society with our colleagues. These efforts allowed people to understood that transplantation was a life-saving procedure and that transplant recipients were continuing their lives as healthy human beings. Through our use of the media, we were able to persuade our Parliament, officials at the Board of Religious Affairs, the Ministry of Health, and those in other governmental institutions; following our efforts, a statement was published by the Board of Religious Affairs emphasizing that “Only the person to whom one donates one of his/her organs oneself is responsible for all his/her good and evil deeds” (Figures 3A, 3B).

Finally, on June 3, 1979, the Law No. 2238 on harvesting, storage, grafting, and transplantation of organs and tissues was passed in the Parliament; this law was deemed progressive enough to be used as a model by many other countries. After the Law No. 2238 was passed, our team performed the first domestic deceased-donor kidney transplan­tation in the Transplantation Unit on July 27, 1979, through a kidney from a citizen who died in a motorcycle accident at Hacettepe University Hospitals (Figure 4A and 4B).^30,31

Regardless of the fact that blood type ABO was a precondition for a successful kidney transplant for many years, recent studies have shown that kidney transplant operations through kidneys from donors with blood type A2 to patients with the blood type O produced positive results, and it is possible to conduct a kidney transplant operation for the cases where there is blood ABO incompatibility between the patients and donors through splenectomy and plasmapheresis application before the transplant operation.^34,35

Seeking ABO blood compatibility before kidney transplant limits the organ sources for patients with kidney diseases.

It is not a rare case where the patient has a relative with ABO blood incompatibility despite the HLA compatibility. Therefore, we developed the “donor-specific skin graft” model for patients with ABO blood incompatibility.³⁶ With this model, which we apply as a preliminary examination for patients with ABO blood incompatibility, it is possible to conduct transplant operations for patients with several organ diseases.

Liver transplant methods have been developed through experimental operations conducted in dogs. The first article on liver transplant in dogs was published in 1955 by C. S. Welch.³⁷ The first liver transplant operation was conducted on a human in 1963 by Dr. Thomas E. Starzl; however, the patient died shortly after the operation.³⁸ The first successful liver transplant operation was conducted by Dr. Starzl in 1967, but the patient was kept in the center for treatment of liver failure.³⁹ According to Starzl, Dr. R. Calne (Cambridge) and Dr. Pichmayr (Hannover) conducted liver transplant operations in their countries.40,41 Until the 1980s, approximately 200 liver transplant operations had occurred around the world as developments in immunosuppressive treatments and use of cyclosporine A had started; these were put into use in several centers in America, Europe, Australia, and South Africa.^42,43

In 1970, a transplant research program was established at Hacettepe University Hospitals in the Department of General Surgery, and I was a third year resident during that time. We began performing experimental liver transplantations on pigs using porta to right atrium bypass with Dr. Burhanettin Savan, but this method was unsuccessful and I decided to continue the program using dogs (Figure 5A) and performed liver transplantation without bypass and it was successful (Figure 5B).⁴⁴

In the 1980s, I also successfully performed partial auxiliary heterotopic experimental liver trans­plantations on dogs (Figure 6A and 6B).

In the meantime, even after the Law No. 2238 was passed and the number of facilities had increased, it was still apparent some years later that the organ supply from deceased donors was still not enough. Unfortunately, thousands of people in Turkey were dying in car accidents, and again, perfectly viable organs were being lost. Therefore, in 1982, I applied again to the government, and the law on organ and tissue transplantation was amended (Law No. 2594) on January 21, 1982 (Figure 7A). This law stated that, after a car accident or a natural disaster, if the relatives of a deceased person could not be reached, then the organs could be harvested without having to obtain the consent of the relatives. In such cases, a post mortem examination is carried out and the report of the Examination Committee is recorded in the protocol for judicial examination. Today, organ transplants are still performed according to these laws (Law No. 2238 and Law No. 2594).

Following the new law, the first successful deceased-donor liver transplantation in Turkey, in the Middle East, and in Northern Africa was performed by our team on December 8, 1988, at the Turkish Transplantation and Burn Treatment Foundation Hospital (Figure 7B).^46,47 After this first liver transplant operation, our “Liver Transplantation Program from Deceased-Donor” started to be applied as a standard treatment method in our center and in Turkey.

At that time, liver transplantations were performed only from deceased donors. However, it was not enough due to the high number of patients on the wait lists. Therefore, I started to think about partial left liver lobe living related donor transplantation in which the first attempts were made by Raia and associates,⁴⁸ Strong and associates⁴⁹ and Broelsch and associates.⁵⁰ After a while, our team performed the first pediatric segmental living-related liver transplantation to a 1 year old on March 15, 1990 at the Turkish Transplantation and Burn Treatment Foundation Hospital, and this was the first in Turkey, the Middle East, and in Europe^46,51 (Figure 8).

One month later, our team succeeded in performing the first adult segmental living-related liver transplantation (left lobe) in the world on April 24, 1990, at the same hospital (Figure 9).^52-54,64,65

On May 16, 1992, our team performed the first combined liver-kidney transplantation from a living-related donor, which was the first operation of its kind anywhere in the world55 (Figure 10).

Multiple organ transplantations are still applied as an alternative method even though they are rare. As a matter of fact, its practicability was shown by our team when we conducted a transplant operation with a segmental liver and a kidney at the same time.55 Additionally, heterotopic partial living-related and deceased-donor transplantations were per­formed by our team as well (Figure 11).^56-65

The level of social awareness raised in recent years has made organ transplant research studies more current and popular both in Turkey and in the world. Tables 1 and 2 and 3 show transplant activities including kidney, liver, heart, heart valve, pancreas, cornea, and bone marrow transplant operations, which have been conducted successfully both in Turkey and in Başkent University hospitals from 1975 to January 2020. Our goal is to develop new and alternative solutions for transplant problems, especially ones related to deceased-donor transplant, which remains an important global problem. Deceased-donor transplant provides many patients with chronic organ disease an opportunity to live.

Despite ongoing research since the 1970s on Tissue and Organ Transplantation operations, continued studies and interinstitutional coordination will provide good results in the near future and will allow patients with chronic organ disease to have hope.

Conclusions

Organ shortages remain the greatest challenge facing the field of organ transplantation today. Millions of people die and are buried with healthy organs, which could save the lives of many patients who continue to wait on transplant lists. This is the responsibility of the international transplant community to ensure that the growing demand for organs is met within ethical and legal boundaries and to create a system of meeting the organ demand entirely with deceased organ donation.

References:

1. Druml W, Druml C. Emerich Ullmann (1861-1937): Not only a pioneer of kidney transplantation. J Nephrol. 2004;17(3):461-466.
   PubMed
   
2. Carrel A. La technique operatoire des anastomoses vasculaires et al transplantation des visceres. Lyon Medical. 1902;98:859.
   
3. Medawar PB. The behaviour and fate of skin autografts and skin homografts in rabbits. J Anat. 1944;78:176-199.
   PubMed
   
4. Hamilton DN, Reid WA. Yu. Yu. Voronoy and the first human kidney allograft. Surg Gynecol Obstet. 1984;159(3):289-294.
   PubMed
   
5. Hume DM, Merrill JP, Miller BF, Thorn GW. Experiences with renal homotransplantations in the human: report of nine cases. J Clin Invest. 1955;34(2):327-382.
   CrossRef - PubMed
   
6. Starzl TE, Barker C. The origin of clinical organ transplantation revisited. JAMA. 2009;301(19):2041-2043.
   CrossRef - PubMed
   
7. Murray JE, Merrill JP, Harrison JH. Kidney transplantation between seven pairs of identical twins. Ann Surg. 1958;14883:343-359.
   CrossRef - PubMed
   
8. Bradley JA, Hamilton DNH. Organ transplantation: an historical perspective. In Hakim NS, Danovitch GM, eds. Transplantation Surgery Springer-Verlag, 2001:1-21.
   CrossRef
   
9. Hamburger J, Vaysse J, Crosnier J, Auvert J, Dormont J. Kidney homotransplantation in man. Ann N Y Acad Sci. 1962;99:808-820.
   CrossRef - PubMed
   
10. Schwartz R, Stack J, Dameshek W. Effect of 6-mercaptopurine on primary and secondary immune responses. J Clin Invest. 1959;38:1394-1403.
    CrossRef - PubMed
    
11. Calne RY. The rejection of renal homograft: inhibition in dogs by 6-mercaptopurine. Lancet. 1960;1(7121): 417-418.
    CrossRef - PubMed
    
12. Zukoski CF, Lee HM, Hune DM. The prolongation of functional survival of canine renal homografts by 6-mercaptopurine. Surg Forum. 1960;11:470-472.
    
    
13. Hitchings GH, Elion GB. Chemical suppression of the immune response. Pharmacol Rev. 15:365-371.
    
    
14. Hume DM, Magee JH, Prout GR Jr et al. Studies of renal homotransplantation in man. Ann N Y Acad Sci. 1964;120:578-606.
    CrossRef - PubMed
    
15. Starzl TE, Marchioro TL, Rifkind D, Rowlands DT, Waddell WR. Clinical experience with organ transplantation. South Med J. 1965;58:131-147.
    CrossRef - PubMed
    
16. Reemtsma K, McCracken BH, Schlegel JU et al. Renal heterotransplantation in man. Ann Surg. 1964;160 (3):384-408.
    CrossRef - PubMed
    
17. Starzl TE, Marchioro TL, Holmes JH et al. Renal homografts in patients with major donor-recipient blood group incompatibilities. Surgery. 1964;55(2):195-200.
    PubMed
    
18. Starzl TE, Putnam CW. Experience in hepatic transplantation. W.B. Saunders Company. 1969.
    
    
19. Hoffenberg R. Christiaan Barnard: his first transplants and their impact on concepts of death. BMJ. 2001; 323:1478-1480.
    CrossRef - PubMed
    
20. Hayry. P. Organ transplantations: from basic research to clinical applications. A personal odyssey. Int J Dev Biol. 1989;33(1):189-195.
    PubMed
    
21. Lee HM. Reflections on the development of organ transplantation. Organ Transplantation. Abouna GM, Kumar MSA, White AG, eds. Kluwer Academic; 1991:1-3.
    CrossRef
22. Humphries. Jr. L.A. Dennis. Jr. A.J: Historical Developments in Preservation. Organ Procurement, Perfusion and Preservation for Transplantation (ed. L.H. Toledo-Pereyra) pp: 1-25, Academic Press, 1982.
    
    
23. Belzer FO, Ashby BS, Dunphy JE. 24-hour and 72-hour preservation of canine kidneys. Lancet 1967;2(7515):536-538.
    CrossRef
    
24. Gritsch HA, Danovitch GM, Wilkinson A. Kidney transplantation. In: Hakim NS, Danovitch GM, eds. Transplantation Surgery. Springer-Verlag; 2001:135-180.
    CrossRef
    
25. Haberal M, Bilgin N, Büyükpamukçu N et al. Living-related kidney transplantation in Turkey. G. M. Abouna et al. (eds.), Current Status of Clinical Organ Transplantation. pp: 209-213 Martinus Nijhoff Publishers, The Hague 1984.
    CrossRef
    
26. Haberal M. Kidney disease and transplantation: my journey. Saudi J Kidney Dis Transplant. 2005;16(4): 612-621.
    
    
27. Haberal M, Oner Z, Karamehmet M, Yenia I, Bilgin N. Transplantation of imported cadaver kidneys. Kidney Int. 26(1984);483-659.
    
28. Haberal M, Z Oner, M Karamehmetoglu, H Gulay, N Bilgin. Cadaver kidney transplantation with cold ischemia time from 48 to 95 hours. Transplant Proc. 1984;16(5)1330-1332.
    PubMed
    
29. Haberal M, Sert S, Aybasti N, Gulay H, Arslan G, Gungen Y, Kucukali T, Bilgin N. Cadaver kidney transplantation cases with a cold ischemia time of over 100 hours. Transplant Proc. 1987 Oct;19(5):4184-4188.
    PubMed
    
30. Haberal M, Moray G, Bilgin N. Cadaver kidney transplantation in Turkey. Transplant Proc. 1999;31: 3377-3778.
    CrossRef
    
31. Haberal M, Gülay H, Karpuzoğlu T, et al. Multiorgan harvesting from heart-beating donors in Turkey. Transplant Proc. 1991;23(5):2566-2567.
    PubMed
    
32. Haberal M, Moray G, Karakayali H, Bilgin N. Transplantation legislation and practice in Turkey: A brief history. Transplant Proc. 1998;30:3644-3646.
    CrossRef - PubMed
    
33. Haberal M, Moray G, Karakayali H, Bilgin N. Ethical and Legal Aspects, and the History of Organ Transplantation in Turkey. Transplant Proc. 1996;28(1):382-383.
    PubMed
    
34. Alexandre GP, Squifflet JP, De Bruyere. M. Present experiences in a series of 26 ABO-incompatible living donor renal allografts. Transplant Proc. 1987;19(6):4538-4542.
    PubMed
    
35. Brynger H. Long-term outcome in renal transplantation. In Abouna GM, Kumar MSA, White AG, eds. Organ Transplantation. Kluwer Academic; 1990:163-165.
    CrossRef
    
36. Haberal M, Gülay H, Arslan G, Sert S, Altunkan S, Bilgin N. ABO Incompatible kidney transplantation with donor-specific skin graft. Renal Failure 1991;13 (2-3)103-110.
    CrossRef - PubMed
    
37. Welch CW. A note on the transplantation of the whole liver in dogs. Transplant Bull. 1955;2:54–55.
    
    
38. Starzl TE, Putnam CW. Experience in hepatic transplantation. Science. 1970;167(3917):364.
    CrossRef
    
39. Starzl TE, Groth CG, Brettschneider L et al. Orthotopic Homotransplantation of the human liver. Annals of Surgery. 1968;168(3):392-415.
    CrossRef - PubMed
    
40. Starzl TE. The co-development of liver and kidney transplantation (1955-1967). Southeast Asian J Trop Med Public Health. 2003;34(2):238-241.
    PubMed
    
41. Starzl TE. The long reach of liver transplantation. Nature Medicine. 2012;18(10):1489-1492.
    CrossRef - PubMed
    
42. Busuttil RW, De Carlis LG, Mihaylov PV, Gridelli B, Fassati LR, Starzl TE. The first report of orthotopic liver transplantation in the Western world. Am J Transplant. 2012;12(6):1385-1387.
    CrossRef - PubMed
    
43. McKenna GJ, Klintmalm GBG. The history of liver transplantation. In: Busuttil R, Klinmalm G, eds. Transplantation of the Liver. 3rd ed. Elsevier Saunders; 3-22.
    
    
44. Haberal M, Bilgin N, Sanaç Y, Güre A, Bor N. Köpekte baypas kullanılmadan yapılan ortotopik karaciğer homotransplantasyonu. Hacettepe Tıp/Cerrahi Bülteni. 1972;5(4): 462-474.
    
    
45. Haberal M. The technique of partial auxiliary heterotopic liver transplantation in dogs. Hacettepe Tıp/Cerrahi Bülteni. 1980;13(1):1-11.
    
    
46. Haberal M, Gülay H, Büyükpamukçu N, et al. Liver transplantation in Turkey. Transplant Proc. 1991;23(5): 2563-2565.
    PubMed
    
47. Haberal M, Tokyay R, Telatar H, et al. Living related and cadaver liver transplantation. Transplant Proc. 1992;24(5):1967-1969.
    PubMed
    
48. Raia S, Nery JR, Mies S. Liver transplantation from live donors. Lancet. 1989;334(8661):497.
    CrossRef - PubMed
    
49. Strong RW, Lynch SV, Ong TH, Matsunami H, Koido Y, Balderson GA. Successful liver transplantation from a living donor to her son. N Engl J Med. 199024;322(21):1505-1507.
    CrossRef - PubMed
    
50. Broelsch CE, Emond JC, Whitington PF, Thistlethwaite JR. Baker AL, Lichtory JL. Application of reduced size living transplants as split grafts, auxiliary orthotopic grafts and living related segmental transplants. Second International Congress of the Middle East Society for Organ Transplantation. Abstract. 1990;47.
    CrossRef
    
51. Haberal M, Telatar H, Bilgin N. Living related liver transplantation in an adult and a child. W. Land, J. B. Dossetor (Eds.) Organ Replacement Therapy: Ethics, Justice and Commerce. Springer-Verlag Berlin Heidelberg; 1991:83-92.
    CrossRef
    
52. Haberal M, Büyükpamukçu N, Telatar H et al. Segmental living liver transplantation in children and adults. Transplant Proc. 1992;24(6):2687-2689.
    PubMed
    
53. Haberal M, Büyükpamukçu N, Telatar H et al. Segmental living liver transplantation as an alternative method. Gastroenterology. 1992;3(3):455-459.
    
54. Haberal M, Abbasoğlu O, Büyükpamukçu N, Bilgin N, Telatar H, Besim A. Segmental living related donor liver transplantation in childhood. Transplant Proc. 1993;24 (3):2200-2202.
    PubMed
    
55. Haberal M, Abbasoğlu N, Büyükpamukçu N et al. Combined liver-kidney transplantation from a living related donor. Transplant Proc. 1993;25(3):2211-2213.
    PubMed
    
56. Haberal M, Moray G, Bilgin N et al. A preliminary report on heterotopic segmental living-related and/or split-liver cadaver transplantation. Transplant Proc. 1999;31:2899-2901.
    CrossRef - PubMed
    
57. Haberal M, Karakayali H, Boyacioglu S et al. Successful living-related heterotopic auxiliary liver transplantation for chronic Budd-Chiari syndrome. Transplant Proc. 1999;31:2902-2903.
    CrossRef - PubMed
    
58. Haberal M, Arda IS, Karakayali H et al. Heterotopic segmental liver transplantation in children. Transplant Proc. 2000;32:535-536.
    CrossRef - PubMed
    
59. Haberal M, Arda IS, Karakayali H et al. Successful heterotopic segmental liver transplantation from a live donor to a patient with Alagille syndrome. Journal of Pediatric Surgery. 2001;36(4):667-671.
    CrossRef - PubMed
    
60. Haberal M, Karakayali H, Emiroglu S et al. Heterotopic liver transplantation during adolescence. Transplant Proc. 2001;33:2832-2833.
    CrossRef - PubMed
    
61. Haberal M, Emiroglu R, Arslan G, Karakayalı H, Moray G, Bilgin N. Long-term survival with heterotopic liver transplantation. Transplant Proc. 2002;34:2468-2471.
    CrossRef - PubMed
    
62. Boyvat F, Aytekin C, Firat A, Harman A, Karakayalı H, Haberal M. Diagnostic and therapeutic management of hepatic artery thrombosis and stenosis after orthotopic and heterotopic liver transplantation. Transplant Proc. 2003;35:2791-2795.
    CrossRef - PubMed
    
63. Haberal M, Sevmis S, Karakayali H et al. Long-term survival in a patient after heterotopic segmental auxiliary liver transplantation. Pediatr Transplantation. 2008;12:816-820.
    CrossRef - PubMed
64. Haberal M. Historical Summary of Liver and Kidney Transplantation in Turkey and in the World. Boyvat F, Haberal M (Eds). Diagnostic and Interventional Radiology in Liver & Kidney Transplantation. pp:3-24, Başkent University Publisher, 2020.
    
65. Haberal M, Karakayali H. The Near and Middle East. Rainer W. G. Gruessner, Enrico Benedetti (Eds). Living Donor Organ Transplantation. pp:32-37, The McGraw-Hill Companies, Inc., 2008.