When faced with a chronic condition, you will need to go through a detailed treatment plan over several months or years to help improve your condition. After a while, you may find that your body is responding to the treatment. But you can be like thousands of people when you realize that your condition is progressing despite the efforts of you and your doctor. You may feel like you will never recover. When faced with a difficult decision about the next steps to take, you may conclude that an organ transplant is your best option.
Many people need organ transplants. Some genetic conditions, such as a heart defect or cystic fibrosis, require a transplant, while other chronic conditions, such as chronic kidney disease, cirrhosis, and diabetes, are also reasons for organ transplants. In 2021, more than 40,000 life-saving organ transplants were performed and a record number of kidney, heart and liver transplants were performed. Studies have revealed that more than two million years of life were saved in a 25-year period, and that organs donated during these years improved the quality of life.
What is Organ Transplantation?
Organ transplantation is a major life-changing surgery that can significantly improve the lives of recipients. Organ donation and transplantation is the process of taking an organ from one person (donor) and surgically placing it in another person (recipient) to replace the failed organ. This surgery is one of the greatest advances in modern medicine, but unfortunately not everyone who needs a transplant can have it.
How Does Organ Transplant Work?
To receive a transplant, the recipient must be evaluated by a healthcare professional before being accepted into a transplant program. Each transplant program sets its own standards for accepting candidates. Here are some things a transplant program might consider to determine if you’re eligible for a transplant:
Current physical and psychological health
Risk factors such as obesity, smoking and heart disease
After being accepted into a program, the patient will be placed on the transplant list. It maintains a national list of organ transplants and transplants and constantly matches organ donors with recipients. Once an organ is ready for use, the local organ procurement team sends medical, social and genetic information to the appropriate places and then a list of potential recipients is created based on factors such as:
The medical urgency of the patient’s illness
Time on the waiting list
Geographical distance between transmitter and receiver
When a match is made, the relevant center contacts the transplant center with the best matched receipt, the Team can accept or reject the organ based on the patient’s current medical condition. If they choose to reject the organ, it will go to the next best match on the list until the organ is placed.
What You Need to Know About Transplant Surgery?
If you and your doctor have decided that a transplant is a good option for you to consider, or if you are already on the waiting list, here are some facts you should know before having transplant surgery.
1. Finding an Organ Match Can Take Years
You will be placed on a waiting list after you pass the initial test to confirm that you are a good candidate for an organ transplant. The waiting list is the master list of candidates from every transplant program registered to receive an organ transplant. Waiting times for transplants vary and depend on a variety of factors such as:
Ease of finding a partner
The type of organ that needs to be transplanted also plays a primary role in waiting times. The national average waiting time for a transplant:
Small Intestine – 2-3 months
Liver – 6-11 months
Heart – 1 year
Pancreas – 1-2 years
Lungs – 2-3 years
Kidney – 3-5 years
Your medical condition and other factors will determine how long you can wait for an organ. Sometimes, the wait can be very short. Other times, patients may wait 5 years or longer for an organ. There are still patients who will not receive a transplant. About 17 people die every day while waiting for an organ transplant. This is largely because the demand for organs is significantly higher than the supply.
2. Transplanted Organs Don’t Last Forever
A healthy organ transplant to replace a diseased or failing organ can prolong life and lead people to a better quality of life. However, it still has its limits.
Transplant for organ transplant
Most organs are taken from people who have died, usually due to brain death. They are removed from the donor body, placed in a refrigerator, transported by car or plane, and then placed in a patient already compromised by their condition. From the time the organ donor is transplanted to the recipient, it goes through a cycle of injury that can cause problems with the transplanted organ later in life.
Some organs last longer than others, depending on the organ’s role. On average, kidney transplants take the longest, with an average of 10-12 years. Meanwhile, 75 out of 100 people who have a liver transplant live an average of 5 years after the transplant. Heart and lung transplants have the highest risk. For people who have a heart transplant, only 70 out of 100 live 5 years. The average lifespan of a transplanted lung is 5-7 years, as the lungs are the most exposed to the different elements you can breathe, such as cold air and smoke.
The half-life of an organ varies from person to person and depends on the person’s health and post-transplant care.
3. Transplanted Organs May Carry Hidden Diseases
Donor organs are screened for common infections and diseases that can be transmitted to recipients through the transplanted organ. The Organ Procurement and Transplant Network has policies and regulations that require the donor’s medical and social history. They collect information such as:
Risky behaviors that may have exposed the donor to the disease
Past medical history
Relevant travel history
The Organ Procurement and Transplant Network’s policies also require laboratory tests to see if the donor has infections such as:
hepatitis B or C
Epstein Barr Virus (BVS)
While testing protocols exist to ensure that healthy organs are donated, deliberate transplantation of organs with hepatitis B and C is accepted in medical practice. Although these organs are typically transplanted into recipients with the same infection, they can still be transplanted into uninfected patients in case of urgent medical need. A recent study looked at donor-derived disease in transplant patients from 2008 to 2017. Of the 355 proven or probable infected donors, 244 donors became infected. While it constitutes 24% of the diseases transmitted by hepatitis C, it constitutes 14% of the diseases transmitted by hepatitis B.
In the past two years, the risk of contracting COVID-19 in lung transplant patients has also been a concern. In February 2021, a woman contracted COVID-19 and died two months after receiving a double lung transplant from a donor who had the virus but tested negative. While this may seem like an isolated incident, it still raises concerns about donor screening and the Organ Procurement and Transplant Network.
4. A Transplant Could Be a Better Course of Treatment
Most diseases that cause organ damage are progressive, meaning they get worse over time. While some treatment plans can help delay damage, most damage cannot be reversed. When there is too much damage, the organ may fail. When an organ fails, not only does it need to be replaced with a healthy organ, it can affect other organs, tissues, and systems in the body that rely on the failing organ. This can cause even more damage to the body, such as heart problems, chronic inflammation, and infection.
The kidneys are at highest risk for other affected organs, especially the pancreas. Kidney-pancreas transplant is a common transplant surgery that is often performed for those who experience kidney failure as a result of complications of Type 1 diabetes.
In one study conducted, one-third of dialysis patients surveyed said they did not know that transplantation was an option. People who know about a transplant are almost three times more likely to have a transplant. The sooner you get listed for a transplant, the better your health outcome will be, as the waiting list can take several years.
5. Post-Transplant Infection May Develop
Infections are common after transplant surgery. This is because the risk of infection is increased due to immunosuppressive drugs taken to prevent the immune system from attacking the new organ. These drugs help ensure your body doesn’t reject the organ, and they also reduce your immune system’s ability to fight viruses and bacteria. While immunosuppressive medications are highest, people are at greatest risk of infection immediately after surgery, while the risk of infection persists long after surgery.
man with stomach ache
Any infection occurring within the first 30 days after surgery is likely to be bacterial. Some bacterial infections include vascular catheter, pneumonia, colitis, and surgical site infections. Between 30 days and 6 months after transplant, infections associated with the immunocompromised state surface. These include pneumocystis, fungi, toxoplasma gondi, Nocardia and CMV. Cytomegalovirus (CMV) is a type of herpes virus that affects an average of 20% of transplant patients. It can affect almost any organ and cause a variety of symptoms. Some common symptoms of CMV include:
Fever with a temperature higher than 100.4
low white blood cell count
Abdominal pain and nausea
Although symptoms help identify infection, most CMV infections are asymptomatic (symptomless), making diagnosis difficult. Doctors will typically do blood tests or urine cultures to determine if you have CMV. Like most infections, CMV can be treated with antiviral medications. However, after infection, it will remain dormant in the body for life.
6. You Can Reject the Organ
Organ rejection can happen after a transplant. Even when immunosuppressants are used to reduce the risk of rejection, the body may identify the new organ as a foreign body and attack it to protect the body from harm. Studies show that about 10-20% of patients will experience at least one rejection period between one and three months after surgery.
The immune system is designed to protect you from harmful substances such as germs, bacteria and viruses. All harmful substances have proteins called antigens that coat their surface. As soon as the body detects antigens, the immune system recognizes them as foreign and attacks them so as not to harm the body. Organs also carry antigens, so when a recipient receives a new organ whose antigens don’t “match”, the body identifies it as an invader. Incompatible organs can cause transplant rejection.
There are three types of rejection:
Hyperacute rejection. This happens a few minutes after transplantation, when the antigens in the new organ, the molecules that stimulate an immune system response, do not match those of the recipient. In this case, the organ must be removed immediately, or it will be fatal.
acute rejection. This type of rejection occurs between one week and 3 months after transplant surgery. Most patients will have some degree of acute rejection.
Chronic rejection. This happens over several years as the body’s immune response to the new organ gradually damages the transplanted organ.
Although doctors do their best to prevent organ rejection through a series of pre-transplant tests, organ rejection can still occur. This is because everyone’s immune system reacts differently to transplanted organs, no matter how close the match is.
If you begin to notice signs of rejection near the transplant site, such as tenderness, fever, or other extreme flu-like symptoms, it’s important to call your doctor immediately.
Is a Transplant Right for You?
Consult your medical care team and loved ones when it’s time to decide whether a transplant is the right option for you. After talking to the people closest to you and still not sure if this is the right choice, you may want to consider connecting with others who have had transplant surgery.
Writer: Tuncay Bayraktar