An organ transplant replaces a failing organ with a healthy organ. A transplant surgeon will remove an organ from another person and place it in your body. This may be done when your organ has stopped working or stopped working well because of disease or injury.
Not all organs can be transplanted, and not every province allows every type of organ to be transplanted. Organs most often transplanted include:
More than one organ can be transplanted at one time. For example, a heart/lung combined transplant is possible.
Not everyone is a good candidate for an organ transplant. The transplant centre will do tests to see if you are. Your doctor will send a referral to the transplant centre to have your file reviewed for transplant candidacy.
Once the transplant team sees you and completes all the investigations, tests and consults and your tests all show you are a good candidate, you are put on a waiting list. It may be days, months, or years before a transplant takes place.
Organ transplants have been done in Canada since the 1950s. The procedure is always improving, and transplants are more successful today than ever before. Organ transplant success depends on:
First, your transplant coordinator will advise you how often you'll need to have blood and tissue tests done. Tissue tests are used to match you against a donor. The blood tests are done to monitor your condition while waiting.
You'll need to take care of your health. Continue to take your medicines as prescribed and get regular blood tests. Follow your doctor's and transplant center's directions for eating and exercising. You also may want to talk with a psychiatrist, psychologist, or counsellor about your transplant.
You may have to wait days, months, or years for your transplant. Be patient, and ask your doctor what you can do while you're waiting.
Depending on the centre and the organ group, you may need to relocate closer to the transplant facility to complete months of testing.
After a transplant, many people say they feel better than they have in years. What you can and can't do will depend on the type of transplant you had, other health problems you have, and how your body reacts to the new organ.
You will have to take daily medicines for the rest of your life to prevent your immune system from rejecting the new organ.
You will also have regular checkups and blood tests to see how well your new organ is working. These will be frequent and directed by the transplant centre. You will have blood work at least monthly for the rest of your life.
Some people feel depressed after an organ transplant. If you think you may be depressed, get help. The earlier depression is treated, the more quickly you will feel better.
You may need to make lifestyle changes to keep your new organ healthy and strong. This can include eating healthy foods, getting regular exercise, and getting enough sleep. Your doctor can help you plan any needed changes. Keeping in touch with your transplant coordinator and your local primary doctor, taking your medicines, going to your doctor appointments, and making lifestyle changes are all important.
Most people can be organ donors. If you are interested in donating an organ, add your name to the Alberta Organ and Tissue Donation Registry
Many people choose to donate an organ upon their death. But a person can donate certain organs while he or she is still living. These people are called "living donors."
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Learning about organ transplant and donation:
After a transplant:
Living with an organ transplant:
is a more common medical procedure today than in the past. People are living longer, which means that disease has a longer time to damage organs. Many diseases can lead to organ failure, including diabetes, cirrhosis, coronary artery disease, hepatitis C, chronic obstructive pulmonary disease (COPD), cystic fibrosis, and Crohn's disease.
If you have been living with a serious chronic disease that has caused a major organ (such as your heart, kidneys, liver, pancreas, lungs, or intestine) to fail, you may want to ask your doctor whether an organ transplant is an option for you. Decisions about whether you will need a transplant are made in consultation with a specialist.
After it is determined that you need an organ transplant, the next step is getting on the organ transplant waiting list:
The transplant centre will notify you to let you know whether you have been placed on the waiting list. If you have questions about your list status, contact the transplant centre where you were evaluated.
It may be days, months, or even years before you receive a new organ. Waiting may be the hardest part of your transplant. Your transplant team will consider whether the donor is a good match for you, the status of your current health, and how long you've been on the waiting list. Your team will also consider the location of the donated organ, because it must be transplanted quickly to remain in working order.
Not everyone is a good candidate for an organ transplant. You will not be considered for organ transplant if you have an active substance misuse problem. Ask your doctor for more information about organ transplantation and whether you would be considered a good candidate.
If you are told that you are not a good candidate for organ transplant, find out if there are other treatments for your condition. Many people can live for years with serious health conditions. If transplantation is not an option, the goal of your care may shift to maintaining your comfort. Talk to your loved ones about the type of care you would like to receive. Discuss their expectations as well as your wishes, care needs, finances, and the needs of your family. Your choices may change as your illness changes.
Because receiving a donor organ is a big responsibility, you'll have to be committed to taking good care of yourself in order to be approved for a donor organ. The best way to do this is to take medicines as prescribed, get regular blood tests, and make any necessary lifestyle changes to stay healthy. Because there are many emotional issues that may come with a transplant, you may find it helpful to see a psychiatrist, psychologist, or a counsellor about your transplant.
While transplantation can be a long and challenging process, your quality of life may be greatly improved.
It is natural for your immune system to destroy invading foreign substances in order to fight off infection and disease. Basically, an organ transplant from someone else is foreign to your body. When a new organ is placed into your body, your immune system sees it as foreign and tries to destroy it. The most important weapons to fight this rejection are anti-rejection medicines that prevent your immune system from attacking the donor organ.
There are many ways your loved ones can provide you with support during and after your organ transplant. You will be required to have at least one support person stay at the transplant centre with you during and after your surgery. Before your transplant, this person can talk with the transplant coordinator to arrange for lodging while you are in the hospital. He or she should have a suitcase packed and be prepared to go to the transplant centre with you when you get the call that your organ is available.
The transplant coordinator can also tell the support person where to wait during your surgery. Your support person can be responsible for writing down and asking the transplant team questions during and after your surgery. Also, he or she can stay with you after the surgery and watch for any rejection symptoms or unusual behaviours (such as being overly agitated) that sometimes occur after a transplant.
The support person should know what counselling services are available at the transplant centre and know when to ask for help from an outside resource, such as another family member, community resources, or your place of worship.
Before you can be considered for an organ transplant, you will need to have medical tests to find out whether you are a good transplant candidate and to find out your tissue type. Knowing your blood and tissue type will make matching with a donor organ easier. Some tests are required for all organ transplant candidates. Other tests are needed to monitor your chronic disease or the cause of your organ failure. In general, tests that are done for all organ transplant candidates include:
The results of these medical tests will be used to determine suitability for transplant.
Other things that affect your chance of having a successful organ transplant include:
You may be worried about having an organ transplant, being in a transplant centre or hospital, or being around medical equipment or doctors. You may have concerns that you will not survive the surgery. All are normal concerns. Most people who have had an organ transplant say that it was a good decision and that the surgery and lifelong use of medicines and lifestyle changes are worth it.
The quality of your life can greatly improve. You should have more energy soon after your transplant. You may enjoy physical activities or foods that you haven't been able to enjoy in a long time. After having a transplant, you may feel better than you have in years-many people report feeling better immediately after their transplant, even while recovering from the surgery.
It is always wise to have an advance care plan on file with the transplant centre or hospital where you will receive care. An advance care plan provides instructions about your medical choices should you be unable to make those choices for yourself. It is a good idea to appoint a substitute decision-maker to make your health decisions if you are unable to communicate your wishes. For more information, see the topic Choosing a Substitute Decision-Maker.
It is true that there is a risk of not surviving an organ transplant just as there is with any surgery. There is also a slight risk that your transplanted organ will not function immediately. Some people with kidney transplants from deceased donors require dialysis for a week or more before the kidney functions adequately. Only a few transplanted organs never function. If the donated organ does not work well after your transplant or if it stops working over the years, it may be possible for you to have another organ transplant.
Making the decision to have an organ transplant can be hard. Talking with someone who has had an organ transplant may assure you that you can make the lifestyle changes needed for a long-lasting, successful transplant.
While you are waiting for your organ transplant, you will need to have a cell phone so the transplant centre can contact you at any time to tell you an organ is available. Always keep your cell phone with you. You may also wish to give the transplant centre several numbers where you can be reached and the name and number of a few people who will always know how to reach you.
Arrange for someone to go with you to the transplant centre when you have the organ transplant. This person can support you, listen to your doctor, and can help you remember important instructions from your doctor. This person can also report any change in behaviours or symptoms that you may have either before or shortly after the transplant. It is helpful to have someone who can be there to check in on you during your stay in the hospital and during your recovery at home.
Have your suitcase packed with the things you need to take with you to the transplant centre. Your support person should also have a bag packed and ready to go at a moment's notice. You never know when you will receive the call that your organ is available.
If you are called to the hospital or transplant centre because a donor organ has been found, you will immediately be prepared for surgery while final tests are done to make sure the donor organ is one that will likely work for you.
If your current health condition requires that you be hospitalized while you wait for a donor organ, you will receive supportive and life-saving care (such as blood pressure support for heart failure) until you are matched with a donor organ.
Your recovery time after an organ transplant depends on how healthy you are prior to surgery, which organ was transplanted, and whether your body accepts the donated organ. A longer hospital stay may be needed for a heart or lung transplant than for a kidney transplant. Some people are out of the hospital within a few days after their transplant. Others may need to stay for a few weeks.
Following discharge you will be asked to remain in the local area of the transplant centre for up to three months before you will be able to go home. This is to ensure you have proper physiotherapy to get you strong and to make sure that any early post transplant complications can be addressed quickly.
Your body has a natural defence system called the immune system that protects you from infection and disease. The immune system defends your body by producing antibodies and "killer" cells that destroy foreign substances (such as viruses and bacteria). Since the donor organ doesn't match your own tissue exactly, your body tries to destroy the transplanted organ by rejecting it. Rejection is nature's way of protecting your body.
After an organ transplant, you will need to take anti-rejection medicines, or immunosuppressants, for as long as you have the donor organ. Because your immune system will try to destroy the new organ, anti-rejection medicines are needed to decrease your immune system's response so the new organ stays healthy.
Anti-rejection medicines weaken your immune system and decrease your body's ability to fight infections, cancer, and other diseases. Over the years since organ transplants were first done, these medicines have greatly improved. Researchers are finding out more all the time about how to better regulate the immune system after a transplant. Current medicines still have the potential to speed up illness or create new disease, such as heart problems, diabetes, cancer, and osteoporosis. But these medicines also will save your life by keeping your body from rejecting the donor organ. It is important to take these medicines daily and exactly as prescribed.
Taking medicines daily for the rest of your life is not as hard as it sounds. It may help to talk to someone who has had a transplant and who can assure that you will be able to make the medicines a part of your daily routine. Over time, probably, fewer medicines will be needed. Additional medicines may be needed now and then to fight infection or other health problems related to your transplant.
The anti-rejection medicines you will take after an organ transplant may include:
Corticosteroids, such as prednisone or methylprednisolone. Prolonged use of corticosteroids can cause glaucoma or steroid-induced diabetes and can increase your risk of getting an opportunistic infection (such as pneumocystis pneumonia), which is a type of infection that occurs in people with weakened immune systems. Some experts are finding that some people may be able to avoid the use of steroids or to use them sparingly.
Calcineurin inhibitors, such as tacrolimus and cyclosporine. These block the message that causes rejection. You probably will always need to take calcineurin inhibitors, because they are an important part of your lifelong care after a transplant. These medicines are helpful, but they also have potentially serious side effects such as high blood pressure, too much potassium in the blood (hyperkalemia), and kidney problems. These medicines can also cause nausea, vomiting, diarrhea, high cholesterol, tremors, and seizures. And they can put you at increased risk for infection and cancer. There is a great deal of research on the development of newer calcineurin inhibitors with fewer side effects. Ask your doctor for more information if you are having any of these side effects.
Antiproliferative agents, such as mycophenolate mofetil, azathioprine, and sirolimus. Antiproliferative agents prevent the immune cells from multiplying. These anti-rejection medicines are also an important part of your lifelong care after a transplant. They prevent your immune system from attacking and destroying the donor organ. Common side effects can include nausea, anemia, reduced number of white blood cells (leukopenia), high triglycerides, and intestinal upset. Antiproliferative agents also increase your risk of getting an opportunistic infection, cancer, and other life-threatening conditions.
Monoclonal antibodies, such as basiliximab and rituximab. These antibodies block the growth of immune cells that are responsible for rejection. They are used early after transplantation with calcineurin inhibitors and antiproliferative agents.
Polyclonal antibodies, such as antithymocyte globulin-equine and antithymocyte globulin-rabbit. Polyclonal antibodies temporarily deplete the body's immune cells. These medicines are used in the hours and days immediately after your organ transplant to prevent your body from rejecting the donor organ. They may also be used again if your body starts to reject the donor organ. They are often used to reduce early use of calcineurin inhibitors, which can have serious side effects. Side effects of polyclonal antibodies include fever, itching, joint pain, and decreased number of white blood cells (leukopenia). Severe side effects may include an increased risk for cancer and opportunistic infections, serum sickness (a bad reaction to your own tissues), and a condition that prevents your body from making antibodies that fight infection.
You may have to take other medicines to prevent infection or to control other health problems you have (like high blood pressure).
Almost immediately after a transplant, many people report feeling better than they have in years. The physical limitations you have will depend on the type of transplant you had, other conditions you may have, and whether your body rejects the donor organ. You will likely not face major physical limitations after you have healed from your transplant.
The daily anti-rejection medicines can cause some bothersome and sometimes serious side effects in some people. High blood pressure and high cholesterol are common problems after a transplant, although they can be treated with other medicines. You may be at increased risk for getting certain types of cancer and conditions such as diabetes. You will be at higher risk for infections, especially opportunistic infections, because your anti-rejection medicines will weaken your immune system. Be sure to keep your regular appointments with your doctor or the transplant centre so you can be monitored for these illnesses.
Having an organ transplant may cause many emotional issues both for you and those who care about you. When your organ comes from a deceased donor, you may sometimes think about that and what it meant to the donor's family. It is common to have some depression after an organ transplant, although not everyone does. If you think you may be depressed, it is important to tell your transplant coordinator, doctor, or someone who cares about you. The earlier depression is treated, the more quickly you will recover and the better you will feel.
You can keep your new organ healthy and prolong your life after an organ transplant by:
Lifestyle activities that you can do to keep healthy and prolong the life of your new organ may include:
Having an organ transplant may cause many emotional issues both for you and those who care about you. If your organ came from a deceased donor, you may sometimes think about that and what it meant to the donor's family. It is common to have some depression after an organ transplant, although not everyone does. If you think you may be depressed, be sure to tell your transplant coordinator, doctor, or someone who cares about you. The earlier depression is treated, the more quickly you will recover and the better you will feel.
You will likely have a primary care doctor or specialist to provide for your regular health care after your transplant. Also, your transplant coordinator is a very helpful resource for questions you may have about medicines or what to expect in the months and years after your transplant or if new health issues arise. Your transplant centre or your specialist will direct the post transplant care that is related to your transplant.
Donor organs are in great demand. There currently are over 4,500 people on organ transplant waiting lists across Canada.
Many people choose to donate their organs upon their death. If you decide to be an organ donor upon your death, make sure your family, friends, and doctor know about your wishes. It's also a good idea to include your wish to be an organ donor in your advance care plan. For more information, see the topic Planning to Be an Organ Donor.
People can also donate some organs (such as a kidney or portion of liver) while they are still living. These people are called "living donors." For more information, see the topic Living Organ Donation.
You do not have to be a blood relative (such as a sibling or parent) of a living donor to receive a donor organ. A living donor can be someone who is emotionally related to you such as a close friend or spouse, or the donor can even be a stranger.
Health Resources and Services Administration (2009). 2009 Annual Report of the U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients: Transplant Data 1999–2008. Available online: http://www.ustransplant.org/annual_reports/current.
Other Works Consulted
Klassen DK, Weir MR (2007). Renal transplantation. In DC Dale, DD Federman, eds., ACP Medicine, section 10, chap. 11. New York: WebMD.
Punch JD (2010). Organ transplantation. In GM Doherty ed., Current Diagnosis and Treatment Surgery, 13th ed., pp. 1233–1250. New York: McGraw-Hill.
Trulock EP (2007). Lung transplantation. In DC Dale, DD Federman, eds., ACP Medicine, section 14, chap. 17. New York: WebMD.
Carithers RL, Salvalaggio PR (2009). Liver and pancreas transplantation. In EG Nabel, ed., ACP Medicine, section 4, chap. 15. Hamilton, ON: BC Decker.
Hodson EM, et al. (2008). Antiviral medications for preventing cytomegalovirus disease in solid organ transplant recipients. Cochrane Database of Systematic Reviews (2).
Joyce D, et al. (2011). Surgical treatment of heart failure and mechanical ventricular support. In V Fuster et al., eds., Hurst’s The Heart, 13th ed., vol. 1, pp. 798–809. New York: McGraw-Hill.
Webster AC, et al. (2010). Interleukin 2 receptor antagonists for kidney transplant recipients. Cochrane Database of Systematic Reviews (1).
ByHealthwise StaffPrimary Medical ReviewerE. Gregory Thompson, MD - Internal MedicineBrian D. O'Brien, MD - Internal MedicineAdam Husney, MD - Family MedicineSpecialist Medical ReviewerAnne C. Poinier, MD - Internal Medicine
Current as ofAugust 14, 2016
Current as of: August 14, 2016
E. Gregory Thompson, MD - Internal Medicine
& Brian D. O'Brien, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Anne C. Poinier, MD - Internal Medicine
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