Organ transplant: Replacing diseased organs with healthy ones

If your doctor says you need an organ transplant, the news may not come as a complete surprise. Although a sudden health crisis can result in the need for a transplant, it's more likely you've experienced declining health for some time.

Before deciding on an organ transplant, consider the many steps an organ entails — from waiting for a donor organ and having the surgery to post-surgical recovery and the life-long medical regimen you'll need to follow.

The organ shortage: How limited supply affects your outcome

With many diseases and conditions, your doctor will prescribe medication, recommend lifestyle changes or schedule you for surgery or a procedure. As a result, you'll probably follow your doctor's recommendations and your condition will most likely improve.

But if you need an organ transplant, the process might not go as smoothly — you may not necessarily get the transplant. The primary reason for this is because there aren't enough donated organs for everyone who needs one.

In any given year, approximately 25,000 to 30,000 organ transplants are performed. Yet on any given day, at least 90,000 people in the United States are waiting for a donor organ. New names are added to the waiting list every day.

Steps to take to begin the organ transplant process

If you decide to undergo an organ transplant, you must follow several steps:

• Choose an organ transplant center. Your doctor might refer you to a particular organ transplant center or you can choose one on your own. Check to see whether your insurance company has a list of preferred providers. You can find data on each specific organ transplant program in the United States through the Scientific Registry of Transplant Recipients.
• Undergo an evaluation. After deciding where you wish to have your organ transplant, the organ transplant center will conduct a screening process to evaluate your medical condition as well as your lifestyle and ability to comply with medical instructions. Active drug and alcohol abusers, for instance, aren't acceptable candidates. And being a smoker may disqualify you from certain transplants or may compromise the outcome. A history of carefully following medical instructions is a good sign that you'll have the discipline to follow rigorous post-transplant procedures.

• Get on the waiting list. If the organ transplant center determines you're a good candidate, it will place your name on the national organ transplant waiting list. With certain organs, such as kidney and liver, your organ transplant team may work with you to explore the possibility of finding a family member or friend willing to donate.

  If the initial evaluation suggests that you're not a good candidate, you and your doctors may be able to work together to change or improve whatever factors are keeping you off the organ transplant list. For instance, you may have to prove you've been sober or that you've given up smoking for a set amount of time.

Waiting for an organ transplant

The amount of time you spend on the organ transplant waiting list can vary from minutes to months or years. Not knowing when or if a donor organ will become available can be very stressful. Talk to members of your organ transplant team if you need help coping with the wait. Members of your team can help you develop strategies to ease your anxiety.

How donor organs and organ transplant candidates are matched

When organs are donated, medical characteristics of the organs are entered into a national computer database. This database — maintained by the United Network for Organ Sharing (UNOS) — is part of a national system designed to ensure the equitable distribution of donated organs in the United States.

UNOS matches organs to those with an urgent need for a transplant. Transplant candidates and donor organs are checked for matching blood types. Depending on the organ involved, other factors may include the size and condition of the organ and the recipient's health and ability to get to the transplant hospital quickly. Some preferential treatment is given to children.

Because organs are viable for only a short time after removal, the organ transplant team has just a short amount of time to decide if a donor organ is suitable for the selected candidate. During this time, the transplant team may perform a test to determine whether the organ transplant recipient's immune system will attack the donor organ in an unusually aggressive manner. If the results are favorable and the candidate is available and well enough to undergo surgery, the organ transplant can proceed.

If the organ isn't right for the first candidate, the organ is offered to the next matching candidate on the list. When a match is found, the organ is retrieved from the donor and the surgical procedure takes place.

Which organs can be transplanted?

You may need one organ or you might need more than one, depending on your disease and health status. Kidneys, pancreases, livers, hearts, lungs and intestines can be transplanted. Intestinal transplants are rare, however, and short- and long-term results aren't as good as those of other types of transplants.

Conquering organ transplant rejection: A lifelong battle

Your body comes equipped with an immune system ready to attack and destroy any substance your body considers foreign, such as bacteria, viruses — or a transplanted organ. Organ rejection occurs when your immune system begins to attack the transplant organ. Rejection can occur at any time after an organ transplant procedure but most often occurs within the first few weeks or months.

Acute rejection
Rejection can be either acute or chronic. Acute rejection is the type that most immunosuppressant drugs work to stop or prevent. If acute rejection occurs, you might need to be hospitalized briefly and given high doses of immune-suppressing medications to bring it under control.

Chronic rejection
Another phenomenon that may be partially related to rejection is organ scarring and damage that occurs over time. This is often called chronic rejection, but as the process begins to be better understood, it appears that an immune response may be only one of several factors that contribute to the gradual scarring. Chronic rejection occurs more commonly in transplants from deceased donors.

Finding the right balance
A variety of medications are used to suppress parts of your immune system to prevent rejection. Suppressing your immune system is a balancing act. The optimal result weakens your immune system just enough to prevent rejection, but leaves it as strong as possible to fight infection and disease. Achieving this also balances effective immune suppression with the goal of causing minimal drug side effects.

Common immunosuppressants

You'll need to follow a lifelong regimen of drug therapy after an organ transplant to prevent your body from rejecting the new organ. While these medications may have potential risks and side effects, usually they're well tolerated and are necessary to preserve the viability of your transplant.

You'll likely require a combination of two or more immunosuppressants. These drugs — all of which have side effects — may include:

• Corticosteroids. Although corticosteroids are among the most widely used immunosuppressants, they have many side effects. These include elevated cholesterol and blood pressure, osteoporosis, increased appetite, acne, cataracts, mood changes, a round, puffy face and difficulty sleeping. Corticosteroids remain an important immune-suppressing agent, but they're being used less often for long-term treatment.
• Cyclosporine (Neoral, Sandimmune, Gengraf, others). Credited as the first widely successful immunosuppressant for transplant recipients, cyclosporine is still an effective and widely used immune-suppressing drug. But it's not without side effects, such as kidney problems, elevated blood pressure and cholesterol, increased body hair, swollen gums, headache and elevated blood sugars.
• Tacrolimus (Prograf). This drug can be used in place of cyclosporine, though it shares many of the same side effects. Although it doesn't cause hair growth or gum thickening, as does cyclosporine, it can instead cause fever, sleep problems, diarrhea or anemia.
• Mycophenolate mofetil (CellCept). Used in many types of transplants, mycophenolate mofetil has shown promise in reducing organ scarring over time. Side effects can include diarrhea, nausea, elevated blood pressure and anemia.
• Sirolimus (Rapamune). A newer immune-suppressing drug, sirolimus is less likely to cause kidney problems than other immunosuppressants are. Sirolimus has been approved as a substitute for cyclosporine in kidney transplant recipients who are at low to moderate risk of rejection, and it's been prescribed for other organ transplants, as well. Sirolimus may cause side effects such as increased cholesterol and blood pressure, anemia and headache.

Follow the rules for organ transplant success
Finding the best combination of drugs — and the best dosages — may involve a certain amount of testing and experimentation. While your organ transplant team works to adjust your medications, it's crucial for you to:

• Take your medications exactly as prescribed
• Keep your appointments
• Report any unusual signs or symptoms to your organ transplant team
• Contact your organ transplant team before taking any over-the-counter drugs, herbal or dietary supplements, or prescription medications

Stay vigilant: Be on guard against signs of trouble

A healthy lifestyle — which includes a healthy diet, exercise, maintaining a healthy weight, not smoking and limited or no alcohol use — can be crucial to post-transplant success.

You must also be on the lookout for signs that something more serious is going on, and take measures to guard against their occurrence. Work with your doctor to address these common problems:

Infection
Because your immune system is suppressed, you'll need to take extra precautions to avoid infections. You'll also need to be alert to signs and symptoms of infection — such as a high or sustained fever — and report them to your transplant team. You may be prescribed antibacterial, antifungal or antiviral drugs on an ongoing basis to guard against infection.

Cancer
Immune-suppressing drugs increase your risk of developing certain forms of cancer, so regular screening is important. Most organ transplant recipients develop skin cancer over time. If detected early, nearly all skin cancers can be successfully treated. You may also face an increased risk of cancers of the breast, prostate, cervix, testicles and colon.

Elevated cholesterol and hypertension
Your doctor may prescribe medication to help keep these immunosuppressant side effects in check. Some cholesterol lowering drugs also seem to reduce the risk of rejection.

With challenges come rewards

The first few months after your organ transplant may be difficult. You'll likely be taking a large number of new medications — many requiring frequent adjustments in dosage — and you may be dealing with various medication side effects. You'll also be recovering from a major surgical procedure, and you may be at particularly high risk of developing some kind of infection.

There may be times after the organ transplant when you feel like you've simply traded one set of health problems for another. But weighed against these potential risks and hardships is the prospect of renewed health and life. The majority of organ transplant recipients enjoy many years of improved health that would have been impossible without the transplant.

As you recover and your drug regimen stabilizes and becomes less intense, you'll likely feel stronger and healthier than you've felt in years. Living with an organ transplant is likely to be a continuing challenge. However, there's a good chance your organ transplant will enable you to live a full and active life.

Related

Organ transplant: Coping with the wait