In cases where an essential organ fails and it is not possible to restore its function, a transplant often provides the only chance of survival. Perhaps also a chance at a new outlook on life. Since the first successful kidney transplant was carried out by Joseph E. Murray in the US in 1954, transplant medicine has made such significant progress that many patients are able to improve their quality of life as well as their chance of survival. The success rates we see today are unquestionably a consequence of the development of modern immunosuppressants that prevent the body from rejecting the transplanted organ.
Today we are able to successfully transplant the kidneys, liver, heart, lungs, pancreas and small intestine. In Germany, more than 10,000 people are currently on the waiting list for a donor organ, of whom around 8,000 are awaiting a kidney (Source: German Organ Transplantation Organisation). The reasons for the shortage of donor organs and often long waiting times are many and varied, although the most important is that Germany requires a written agreement to organ donation. Other countries, such as Austria, make a general assumption that everyone agrees to donate their organs and people have to opt out in writing if they prefer not to do so.
ORGANS AND DISEASES
Waiting for a new organ
The basic prerequisite for a successful transplant is that a suitable donor organ is available. However, they are in very short supply. In Germany alone, more than 10,000 people are currently on the waiting list for a transplant, of whom around 8,000 are awaiting a kidney (Source: German Organ Transplantation Organisation). These figures contrast with the 3,488 organ transplants from deceased donors carried out in 2014 (Source: Eurotransplant). Many patients have to wait years for a donor organ. The average waiting time for dialysis patients is 5 to 6 years (Source: German Organ Transplantation Organisation).
For most other organs, the ratio of transplants carried out each year to people still on the waiting list is more positive. And yet transplants of these organs are often more urgent because the respective treatment method cannot guarantee that patients will survive for as long as is possible through dialysis.
What happens during the operation
Once an organ on the waiting list becomes available, things have to move incredibly fast. For a post-mortem donation, typically only a few hours pass between the notification that an organ is available. As a result, it is important for potential organ recipients to be easily reachable at all times. Additionally, patients should be prepared for a longer stay in hospital.
For kidney transplants there is more time available for the preparations than for other organs. 36 hours are allowed to pass between the organ being recovered and being transplanted. A liver must be transplanted within 8 to 9 hours.
The hospital then carries out a number of tests to make sure that the transplant will not negatively affect the patient's state of health. The patient takes a number of medications before the operation. These suppress the body’s natural immune response to reject foreign organs – they are called immunosuppressants.
In kidney transplants, the patient’s own non-functioning kidneys are often left inside the body. The donor organ is transplanted into the lower abdomen and then connected to the major blood vessels in the pelvis. To ensure that urine can flow out of the new kidney, the ureter is sewn into the bladder. This connection is often stabilised using a special catheter that can be removed a few weeks after the transplant.
With the exception of very few metabolic diseases, the recipient’s original liver is always removed in its entirety during a liver transplant. However, the transplanted organ in this case can be either a complete liver or part of a liver. Partial organs grow back to their original size in the space of a few months. The donor organ is inserted in place of the recovered organ and is then connected to the relevant structures.
During the period immediately following the transplant, it is necessary to carry out frequent and regular checks to see how the body is coping with the new organ. Despite the donor and recipient having compatible blood groups and high matches in terms of tissue markers, the body still recognises the new organ as being “foreign”. Our natural immune response can result in the transplanted organ being rejected. To prevent this, the patient must take medications to suppress their body’s immune response. These medications, called immunosuppressants, are given before and during the operation, and the patient will need to take them for life according to very precise dosing instructions. If the patient does not take their medication regularly or stops taking it without their doctor’s approval, it can put the transplanted organ at risk and can lead to a short- or long-term decline in function, and potentially to complete failure with loss of the organ.
LIFE AFTER A TRANSPLANT
The new organ
The patient has had a successful transplant operation. But what happens next? What happens whilst the patient is in hospital, and later on when they are back at home?
Counteracting organ rejection
The most feared complication after a transplant is rejection of the donor organ. So how do we recognise when an organ is being rejected? The earlier that we can identify a rejection response, the lower the risk of losing the transplanted organ.
Signs of rejection can vary depending on the organ. Generally speaking: if one or more symptoms occur then the patient should immediately visit the doctor responsible for their treatment or the transplant aftercare centre. Failure to initiate appropriate treatment quickly can lead to organ loss in just a few days. If rejection responses are identified early on then they usually respond well to treatment with drugs.
For advice on travelling after an organ transplant, visit the Service section.