Transplantation

What is organ transplantation? 

Organ transplantation is a surgical procedure in which a healthy organ is transferred from a healthy donor to a recipient whose own organ(s) have failed or are at high risk of failing due to disease or injury. This procedure can be a life-saving treatment option for individuals with end-stage organ failure. The donated organ may come from a recently deceased or a living donor, depending on the type of transplant. In some cases, only a portion of a living donor's organ may be needed for a successful transplant.

Which organs can be transplanted?

The organs that can be transplanted are:

• Liver
• Kidney
• Pancreas
• Kidney-pancreas (can be transplanted at the same time)
• Heart
• Lung
• Heart-lung (can be transplanted at the same time)
• Intestine
• Vascularized composite allografts, or VCAs, such as face, hand or uterus transplantation

When was the first organ transplant?

The first successful organ transplant was performed in 1954 by Dr. Joseph Murray and his team at Brigham Hospital (now Brigham and Women's Hospital) in Boston. Dr. Murray transplanted a healthy kidney from Ronald Herrick, at age 23, into his identical twin brother, Richard, who had chronic kidney failure. The recipient of the transplant lived for eight years after the procedure. This groundbreaking success paved the way for further advancements in organ transplantation and has saved countless lives since then.

Read more about the history of organ transplantation. 

Can I be too old or too sick to receive a transplant?

While organ transplantation can be a life-saving treatment option for individuals with end-stage organ failure, not everyone is eligible to receive a transplant.  Since each transplant program sets its own practice, there is no standard age limit to be transplanted.  Age, overall health status, and underlying medical conditions are factors that can affect eligibility for a transplant.

Older adults may face increased risks and complications associated with the transplant procedure and may have a reduced life expectancy compared to younger recipients. However, age alone is not a definitive factor in determining transplant eligibility. The patient's overall health status, including other medical conditions they may have, is also taken into consideration.

Individuals with certain medical conditions, such as active infections or cancer, may not be able to undergo a transplant procedure due to the risk of complications or reduced chances of success. Additionally, individuals who have a history of drug or alcohol abuse may also not be considered eligible for a transplant.

It's important to note that the decision to undergo a transplant is a complex one that requires careful consideration by the patient, their healthcare provider, and the transplant team. Each case is evaluated on an individual basis, and many factors are taken into account to determine whether a transplant is the right treatment option.

It's understandable that being told that you may not be eligible for a transplant can be disappointing and difficult to hear. If you have concerns or questions about your eligibility for a transplant, it's important to discuss them with your healthcare provider and transplant team to fully understand your options and what steps can be taken to improve your chances of success.

What do I need to do to be considered for a transplant?

To be considered for a transplant, you will need to undergo a thorough evaluation by a transplant program. The transplant team will review your medical history, perform a physical exam, and conduct various tests to determine if you are a suitable candidate for a transplant.

It is important to note that not everyone who wishes to have a transplant will be accepted as a candidate. Each transplant program has its own set of eligibility criteria and may have different standards for accepting candidates.

If you are not initially accepted as a candidate by one transplant program, it doesn't mean that you won't be accepted by another program. Each team may have different opinions and interpretations of the same medical information, and it's possible that a different program may view you as a suitable candidate.

The decision to undergo a transplant is a complex one that requires careful consideration by the patient, their healthcare provider, and the transplant team. If you are interested in pursuing a transplant, it's important to discuss your options with your healthcare provider and to seek guidance from a transplant program to fully understand the process and eligibility criteria

‍How many organ transplants are successful?

While survival rates differ by organ type, the majority of transplant recipients survive at least one year post-transplant. However, it's important to keep in mind that graft function plays a role in patient survival. Graft survival is the continued function of the transplanted organ. For some organs, graft failure, or loss of the transplant, would immediately jeopardize the patient's life without a repeat transplant.

For example, about 95 percent of kidney recipients continue to have graft function at one year, and nearly 80 percent continue to have kidney function at least five years. However, for organs such as heart, liver, and lung, graft survival is very similar to patient survival.

It's also worth noting that patient survival rates decrease over time, but the rate of decrease generally slows after the first year. So while the first year post-transplant is critical, ongoing medical care and monitoring are essential for long-term success.

Preparing and waiting for transplant

What is the waitlist?

The waitlist is the list of patients who are waiting for an organ transplant. Patients who are in need of a transplant are placed on the waitlist by their transplant program, and the order in which patients are placed on the list is determined by a variety of factors, including the severity of their condition, their blood type, and the availability of organs that match their needs. The waitlist can vary in length depending on the number of patients waiting for a transplant and the availability of donor organs. The waitlist can be a stressful and emotional time for patients and their families as they wait for a life-saving organ to become available.

‍How do I get on the national transplant waitlist?

If you need a transplant, getting on the national transplant waiting list is typically the first step. However, due to the limited availability of donor organs, most patients wait for some period of time before receiving a transplant. Here's how to get on the national waitlist:

1. Ask your doctor for a referral to a transplant hospital.

Your primary care physician or specialist can refer you to a transplant hospital. Make sure to choose a hospital that meets your specific needs, such as location, insurance accepted, and support group availability.

‍

2. Contact the transplant hospital and schedule an evaluation.

Once you have identified a hospital, contact them to schedule an evaluation appointment. During the appointment, the transplant team will assess whether you are a good candidate for a transplant.

3. Ask questions during the evaluation.

It's essential to ask questions during your evaluation to learn as much as possible about the hospital and its transplant team. This will help you make an informed decision about whether to proceed with the transplant process at that hospital.

4. Get added to the national waiting list.

If the transplant team determines that you are a good candidate for a transplant, they will add you to the national waiting list. Keep in mind that each hospital has its own criteria for accepting candidates for transplant.

5. Wait for notification from your transplant hospital.

Within 10 days of being added to the national waiting list, your transplant hospital will notify you of your date of listing. After that, it's a waiting game until a suitable organ becomes available.

By following these steps and working closely with your transplant team, you can increase your chances of successfully receiving a transplant and getting back to a healthy life.

‍How do I know that I am listed?

Typically,once you have completed the evaluation process, your transplant hospital will notify you within 10 days to inform you whether or not you have been listed. You can also contact your transplant hospital to confirm your status on the waiting list. It's important to keep in touch with your transplant team and notify them of any changes in your health or contact information so they can reach you quickly when an organ becomes available.

‍Where am I on the waitlist?

Unfortunately, due to privacy concerns and the complexity of the transplant waiting list, it is not possible for patients to directly access their position on the list. Keep faith, the waitlist is a dynamic, ever-changing pool of information. Where a patient may appear at any point on the waitlist will depend on a number of variables about the organs available and about other people in similar need of a transplant.

Your transplant team can provide you with updates on your status, including any changes to your estimated wait time and any factors that may impact your candidacy. It's important to keep in touch with your transplant team and let them know about any changes in your health status or personal circumstances that may affect your availability for transplant.

‍Can I list at more than one hospital?

Yes, you can list at more than one hospital. This is known as “multiple listing” at transplant centers. Listing at multiple transplant centers can potentially increase your chances of receiving a transplant, as different centers may have varying wait times and access to different donor organs. However, it's important to keep in mind that listing at multiple centers requires careful coordination with each transplant team to ensure that you meet the requirements and expectations of each program. Additionally, some transplant centers may have policies that prohibit listing at multiple centers, so it's important to check with each center before proceeding.

‍What questions should I ask the transplant team?

Asking questions is an important part of the transplant evaluation process and can help you understand the transplant procedure and make informed decisions. Here are some questions you may want to ask the transplant team:

• Am I a candidate for transplantation?
• What kind of medical tests are done in an evaluation?
• What medical conditions might rule me out for a transplant listing?
• Who are the members of the transplant team and what are their jobs?
• How many attending surgeons are available to do my type of transplant?
• What are the risks and benefits of transplantation for me?
• What are the success rates for this transplant procedure?
• How long will I have to wait for a transplant?
• What are the criteria for being placed on the waitlist?
• How will I be notified when an organ becomes available?
• What is the transplant process like, from pre-surgery to post-surgery?
• What are the potential complications and how can they be prevented or managed?
• What is the recovery process like and how long will it take?
• What kind of support is available to me before and after the transplant?
• How will the transplant affect my daily life, including diet, exercise, and medication?
• What kind of follow-up care will I need and how often will I need to be monitored?
• Are there any alternative treatments or procedures I should consider?
• What are the costs associated with the transplant procedure and how will they be covered?
• What can I do to prepare myself physically and mentally for the transplant procedure?

Remember, don't be afraid to ask questions and make sure that you fully understand the answers before making any decisions.

How long will I have to wait?

How will they find the right donor for me?

How can I cover transplant costs?

‍The wait time for organ transplants can vary greatly, and unfortunately, not everyone who needs a transplant will receive one. Due to the shortage of suitable donor organs, only slightly more than half of the people on the waiting list will receive an organ within five years.

‍While you are waiting for a transplant, it is important to prepare yourself both physically and mentally. Working closely with your transplant team and attending all scheduled appointments is crucial. It is also important to build a strong support system with your family, friends, medical professionals, and religious or spiritual leaders. Sharing your experience with your loved ones can provide you with emotional support and valuable information.

‍By taking these steps, you can take control of your situation and better prepare yourself for a transplant.

How can I prepare myself medically while on the waitlist? 

To prepare yourself medically for a transplant, it's important to maintain your overall health and stay in contact with your transplant team. Any changes in your condition should be discussed with your team, as these may affect your eligibility for transplantation. Here are some tips to help you prepare:

‍

• Take care of your health by following your prescribed medications and notifying your transplant coordinator of any health issues or other prescriptions. Keeping your scheduled appointments with your physicians is also important.
• Follow diet and exercise guidelines to manage your weight while waiting for your transplant. A dietician and physical therapist can help you develop a program that will give you the best results. Your transplant team can also provide guidance on how to manage issues with alcohol, tobacco, or drugs.
• Make sure you are available and reachable at all times. Your transplant team needs to know how to reach you, and your transplant coordinator may ask you to stay within a certain geographic range.
• Complete any medical tests or procedures as requested by your transplant team. You should also ask about any elective or required surgeries that are not related to your organ failure.
• If you are a woman of childbearing age, ask your medical team about birth control and pregnancy and what precautions you should take before and after your transplant.
• Stay organized by keeping a binder of your medical records and staying in contact with your transplant team to learn about your waiting list status. This will help you manage your medical information and be prepared for your transplant when the time comes.

‍How can I prepare my personal affairs and get organized while on the waitlist? 

Preparing for a transplant can be a daunting task. From organizing personal affairs to packing bags, there's a lot to do before the transplant. Here are some tips on how to get organized: 

1. Choose a Primary Support Person:

• Select someone who is close to you, has the time and flexibility to be your caregiver, and whom you trust.
• Discuss your needs and expectations with them so that you can ensure that you are not a burden to them.

2. Prepare a Phone/Email Tree:

• Make a list of people who should be informed of your progress.
• Assign someone to be in charge of updating them and cut down on phone/email volume.

3. Organize Your Personal Affairs:

• Fill out an advanced directive and consider writing a will.
• Share access to bank accounts, email, or blogs, as needed.
• Fill out Family Medical Leave Act, insurance, or loan deferment paperwork, if applicable.

4. Consider Dependent Care:

• Find someone you trust and set up a plan to take care of your children and/or pets.
• Ask your doctor when you can expect to see your children and pets after your transplant.

5. Arrange Transportation:

• Plan how you will get to the transplant center quickly when you get the call that an organ is available.
• Plan the driving route and think about traffic conditions.
• If you are relocating, make housing arrangements in advance.

6. Pack Your Bags:

• Be ready to leave as soon as you get the call that an organ is available.
• Include insurance information, a list of medications, an extra 24-hour supply of medication, and other necessities.

By following these steps, you can be better prepared and organized while waiting for your transplant. It's important to discuss any concerns with your transplant team and keep them updated on your progress.

Transplant policies and organ matching

How do I learn about transplant policies?

Learning about transplant policies is an important step in your journey. You can start by contacting your transplant center or the transplant program you're considering. They will provide you with information about the specific policies and procedures they follow. Additionally, the United Network for Organ Sharing (UNOS) in the United States oversees organ allocation and maintains a wealth of information on their website. Your transplant coordinator or social worker can also be a valuable resource in guiding you through these policies and answering your questions.

‍What factors are considered in organ matching and allocation?

Organ matching is a complex process that takes multiple factors into account. These include the severity of your medical condition, your blood type, the distance between you and the donor, and the size and age of the organ. Additionally, the length of time you've been on the transplant waiting list and the compatibility of certain antigens also play a role. Your transplant team will carefully evaluate these factors to ensure the best possible match for you.

‍How are organs distributed?

Organs are distributed based on a national waiting list maintained by UNOS. When an organ becomes available, it is first offered to a patient who is the best match based on a combination of medical factors and the allocation system. This ensures that organs are distributed fairly and based on medical need rather than other factors. The goal is to maximize the chances of successful transplantations and save as many lives as possible.

‍How does the matching process work?

The matching process involves a sophisticated algorithm that evaluates a range of factors. These factors include blood type, tissue type, medical urgency, time on the waiting list, and geographic distance. The algorithm ranks patients on the waiting list to identify the best match for each available organ. The goal is to ensure that the organ is given to the person who needs it the most and has the best chance of a successful transplant.

‍Do transplant hospitals in the U.S. only perform transplants on U.S. citizens?

Transplant hospitals in the United States typically prioritize organ allocation to U.S. citizens. However, they do consider exceptions for non-U.S. citizens, especially if they are living in the U.S. legally. Eligibility can vary by hospital and is subject to federal regulations, so it's crucial to discuss your specific situation with your transplant team. They will guide you on the hospital's policies and any special considerations that may apply to you.

Remember, you are not alone in navigating this process. Your transplant team and support network are here to provide guidance and support every step of the way. Feel free to ask any questions you have, and they will help you understand how transplant policies and organ matching work in your specific case.

‍