When you’re facing a chronic condition, chances are you will have to undergo a few months or years of a detailed treatment plan to help heal your condition. After a while, you may find that your body has been responsive to treatment. But, you may be like thousands of others only to realize that despite your and your doctor’s efforts, your condition has progressed. You may find yourself feeling like you will never get better. Faced with a difficult decision of what next steps you should take, you may come to the conclusion that a transplant is your best option.
Many people need an organ transplant. Some genetic conditions like a heart defect or cystic fibrosis warrant a transplant, while other chronic conditions like chronic kidney disease, cirrhosis, and diabetes are also reasons for an organ transplant. In 2021, over 40,000 life-saving organ transplants were performed, hitting a record number of kidney, heart, and liver transplants. A 2015 study published in JAMA Surgery found that over a 25-year period, more than two million years of life were saved and that the donated organs improved the quality of life during those years.
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What is an Organ Transplant?
Organ transplantation is a major, life-changing surgery that can significantly improve the lives of recipients. Organ donation and transplantation is the process by which an organ is removed from one person (the donor) and surgically placed into another person (the recipient) to replace their failed organ. This surgery is one of the greatest advances in modern medicine, but unfortunately, not everyone who needs a transplant will get one.
How Does Organ Transplantation Work?
To receive a transplant, the recipient must be evaluated by a healthcare professional before being accepted into a transplant program. Every transplant program sets its own standards for accepting candidates. Some things a transplant program may evaluate to determine if you are eligible for a transplant include:
- Blood type
- Current physical and psychological health
- Risk factors like obesity, smoking, and heart disease
Once accepted into a program, the patient will go onto the transplant list. UNOS (United Network for Organ Sharing) maintains the national list of organ procurement and transplantation, and they match organ donors to recipients continuously. Once an organ becomes available, the local organ procurement team sends medical, social, and genetic information to UNOS who then generates a list of potential recipients based on factors like:
- Blood type
- Organ size
- Medical urgency of patient’s illness
- Time on the waiting list
- Geographical distance between donor and recipient
When a match has been made, UNOS contacts the transplant center where the receipt with the best match is located, The team can either accept or refuse the organ based on the patient’s current medical status. If they choose to refuse the organ, it will go to the next best match on the list until the organ is placed.
What Should You Know About Transplant Surgery?
If you and your doctor have decided that a transplant is a good option for you to consider, or may you are already on the waiting list, here are some facts you need to know before you have transplantation surgery.
1. It Could Take Years to Find an Organ Match
Once you have passed the initial testing to confirm you are a good candidate for an organ transplant, you are placed on a waiting list. The waitlist is a master list of candidates from every transplant program who are registered to receive organ transplants. Wait times for transplants vary and are dependent on several factors, such as:
- Medical urgency
- Ease of finding a match
The type of organ that needs to be transplanted also plays a primary role in wait times. The national average wait time for a transplant is:
- 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 will wait for an organ. Sometimes, the wait can be much short. Other times, patients can wait 5 years or longer for an organ. There are still some patients who will never get a transplant. Approximately 17 people die each day waiting for an organ transplant. This is largely because the demand for organs is significantly higher than the supply. As of 2021, there are only 169 million people in the United States who are registered as organ donors.
2. Transplanted Organs Don’t Last Forever
Transplanting a healthy organ to replace a diseased or failed one can prolong life and allow people to live a better quality of life. However, they still have limits.
Many organs are usually harvested from people who have passed away from brain death. They are taken from the donor body, placed into a cooler, transferred by car or plane, then placed into a patient who is already compromised by their condition. From the moment the organ donor passes to the time, it is transplanted into the recipient, it goes through a cycle of injury which may cause issues with the transplanted organ later in life.
Some organs will last longer than others depending on the role of the organ. On average, kidney transplants last the longest at an average of 10-12 years. Meanwhile, out of 100 people who receive liver transplants, 75 of them will live for 5 years post-transplantation. Heart and lung transplants have the highest risk. For people who receive heart transplants, only 70 out of every 100 will live for 5 years. Because lungs are the most exposed to different elements, like cold air and smoke that you may inhale, the average lifetime of a transplanted lung is 5-7 years.
The half-life of an organ varies from person to person and will depend on a person’s health and post-transplant care.
3. Transplanted Organs Can Carry Hidden Diseases
Donor organs are screened for common infections and diseases that could be transmitted to recipients through the transplanted organ. The Organ Procurement and Transplantation Network (OPTN) has policies and regulations that required the medical and social history of the donor. They gather information like:
- Risky behaviors that may have exposed the donor to disease
- Past medical history
- Relevant travel history
OPTN policies also require laboratory testing to see if the donor has infections such as:
- Hepatitis B or C
- Cytomegalovirus (CMV)
- Epstein Barr Virus (BVS)
While testing protocols are in place to ensure healthy organs are donated, intentional transplantation of organs with hepatitis B and C are accepted in medical practice. Although these organs are typically transplanted to recipients who have the same known infection, they can still be transplanted to uninfected patients in cases of urgent medical need. A recent study looked at donor-derived disease (DDD) in transplant patients from 2008 to 2017. Of the 355 donors who transmitted proven or probable disease, 244 donors transmitted an infection. Hepatitis C accounted for 24% of diseases transmitted, while hepatitis B accounted for 14% of diseases transmitted.
In the last two years, the risk of COVID-19 transmission in lung transplant patients is also a concern. In February 2021, a woman contracted COVID-19 and passed away two months after receiving a double-lung transplant from a donor who had the virus but tested negative for it. Although this appeared to be an isolated incident, it still raises concerns about donor screening and DDD.
4. A Transplant May Be a Better Course of Treatment
Most diseases that cause organ damage are progressive, which means they get worse over time. While some treatment plans can help delay damage, most damage cannot be reversed. Once there is too much damage, the organ may fail. When an organ fails, it not only needs to be replaced by a healthy organ, but it can affect other organs, tissues, and systems in the body that relied on the failed organ. This can lead to even more damage to the body like heart problems, chronic inflammation, and infection.
Kidneys are at the highest risk for affected other organs, particularly the pancreas. Kidney-pancreas transplant is a common transplant surgery that is often performed for those who have kidney failure as a result of complications from Type 1 diabetes.
A survey conducted at Penn-Medicine found that one-third of dialysis patients surveyed said they didn’t know transplant was an option. People who are informed about transplants are almost three times as likely to have one. Because the waiting list can take up to a few years, the sooner you are listed for a transplant, the better your health outcome.
5. You May Develop a Post-Transplant Infection
Infections after transplant surgery are common. This is because the risk of infection increases due to immunosuppressive medications that are taken to keep the immune system from attacking the new organ. These medications help to ensure your body doesn’t reject the organ, it also lowers your immune system’s ability to fight viruses and bacteria. While people are at the greatest risk of infection right after surgery when immunosuppressive medications are at their highest, the risk of infection continues long after surgery.
Any infection that occurs within the first 30 days after surgery is likely to be bacterial. Some bacterial infections include vascular-catheter, pneumonia, colitis, and surgical site infections. In the 30 days to 6 months post-transplant, infections associated with the immunosuppressed state being to 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 greater than 100.4
- Low white blood cell count
- Muscle weakness
- Blurry vision
- Abdominal pain and nausea
While symptoms can help identify the infection, the majority of CMV infections are asymptomatic (without symptoms) making it difficult to diagnose. Doctors will typically run blood tests or urine cultures to determine if you have CMV. Like most infections, CMV is treatable with antiviral medications. However, after infection, it will stay inactive in the body for life.
6. You Could Reject the Organ
Organ rejection can happen after a transplant. Even when using immunosuppressants to reduce the risk of rejection, the body can still identify the new organ as a foreign object and attack it, in an attempt to protect the body from harm. Research shows that about 10-20% of patients will experience at least one episode of rejection between one and three months after surgery.
The immune system is designed to protect you can harmful substances, like germs, bacteria, and viruses. All harmful substances have proteins called antigens coating their surface. As soon as the body detects antigens, the immune system recognizes them as foreign and attacks them to prevent harm to the body. Organs also carry antigens, so when a recipient receives a new organ whose antigens are not “matched”, the body identifies it as an invader. Mismatched organs can cause transplant rejection.
There are three types of rejection:
- Hyperacute rejection. This occurs within minutes after the transplant when antigens from the new organ, the molecules that stimulate an immune system response, don’t 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 within one week up to 3 months post-transplant surgery. Most patients will have some level of acute rejection.
- Chronic rejection. This takes place over the course of several years when the body’s immune response against the new organ slowly damages the transplanted organ.
While doctors do their best to prevent organ rejection through a series of pre-transplant tests, rejection can still occur. This is because everyone’s immune system responds differently to transplanted organs, no matter how close the match may be.
If you begin to notice signs of rejection like tenderness near the transplant site, fever, or other extreme flu-like symptoms, it’s important to call your doctor immediately.
Is a Transplant Right For You?
When it’s time to decide if a transplant is a right option for you, consult your medical care team and loved ones. After discussing it with those closest to you and are still unsure about if it is the right choice, you may want to consider connecting with others who have had transplant surgery. At PatientsLikeMe, there are hundreds of members who have had an organ transplant and understand what you are going through. Join the conversation today to learn about others’ experiences with transplant surgery.