Preparing for a Transplant

What causes an organ to stop working?

Organ transplantation 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 usually made in consultation with a specialist.

How do I get on the waiting list?

After it is determined that you need an organ transplant, the next step is getting on the organ transplant waiting list:

• Obtain a referral from your doctor.
• Call the transplant center where you choose to have your transplant. To locate a transplant center near you, ask your doctor or contact the United Network for Organ Sharing by going online at www.unos.org or calling 1-888-894-6361.
• Schedule an appointment for an evaluation at the transplant center to find out if you are a good candidate for transplant. Your transplant center can do all of the required tests, or your doctor can order the tests and send the results to the center.

During your evaluation, it is important to learn as much as you can about the transplant center. You may want to find out whether the center will accept your insurance, what your options are if you don't have insurance, and whether support groups are available. Be ready to ask a lot of questions to make sure the transplant center is a good fit for you.

The transplant center will notify you within 2 weeks of your evaluation to let you know whether you have been placed on the waiting list. If you have questions about your list status, contact the transplant center 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.

What if I am not a good candidate for organ transplant?

Not everyone is a good candidate for an organ transplant. You probably are not a good candidate if you have an active infection, unstable heart disease, or another serious medical problem. Also, you will not be considered for organ transplant if you have an active substance abuse 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.

What do I need to know before having an organ transplant?

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 licensed mental health counselor 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 antirejection medicines that prevent your immune system from attacking the donor organ.

Success rates usually state how many people who receive the transplant are living 5 years after the transplant.¹

• Kidney: About 8 or 9 people out of 10 (82% to 91%)
• Liver: About 7 or 8 people out of 10 (74% to 79%)
• Lung: About 5 people out of 10 (54%)
• Pancreas: About 8 or 9 people out of 10 (85% to 89%)
• Heart: About 7 people out of 10 (75%)
• Intestine: About 6 people out of 10 (58%)

How can my loved ones prepare?

There are many ways your loved ones can provide you with support during and after your organ transplant. It may be helpful to have at least one support person stay at the transplant center 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 center 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 behaviors (such as being overly agitated) that sometimes occur after a transplant.

The support person should know what counseling services are available at the transplant center and know when to ask for help from an outside resource, such as another family member, community resources, or your place of worship.

What tests will I need before my transplant?

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 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:

• A cross-match for transplant. This is a blood test that shows whether your body will reject the donor organ immediately. Antibodies are proteins made by your immune system that attack and destroy foreign substances (antigens), such as bacteria and viruses. The cross-match will mix a donor's blood with your blood to see whether your antibodies attack the antigens of the donor. If they do, you are not a good match with the donor.
• Antibody screen. A panel-reactive antibody (PRA) test measures whether you have antibodies against a broad range of people. And if you do, it means you are at higher risk of having rejection, even if the cross-match shows that you and the donor are a good match.
• Blood type. This is a blood test that shows which type of blood you have—type A, B, O, or AB. Your blood type should be compatible with the organ donor's blood type, although it is sometimes possible to transplant an organ from a donor with a different blood type.
• Tissue type. This is a blood test that shows the genetic makeup of your body's cells. Each of us has genetic markers on the surface of our white blood cells. We inherit three different kinds of markers from our mothers and three from our fathers. The more of these six markers you share with the organ donor, the more likely it is that your body will accept the donor organ.
• A mental health assessment. Because many emotional issues are involved in having an organ transplant, you will be required to take a mental health assessment to identify any psychological issues that may prevent you from receiving and properly caring for your new organ. A living donor is also required to have a mental health assessment before donating an organ.

The results of these medical tests will be used to match you with an organ donor. The more matches you have, the more likely your body will accept the new organ.

What other factors increase my chance for a successful organ transplant?

Other things that affect your chance of having a successful organ transplant include:

• The age of the donor organ. In general, the younger the organ donor, the healthier the tissue. But recent research is challenging this thought. It may be that some older organs work just as well as younger organs.
• The length of time that the donor organ is out of the donor's body. The more quickly an organ is transplanted after it is removed from the donor, the more viable the organ tissue remains. Your team will make every effort to quickly transfer the donor organ.
• How well the organ was preserved just before transplantation. The donor organ must be properly preserved while it is being transferred, especially if it was transferred from a long distance. Your team will make every effort to make sure the donor organ is properly transferred to your location.

What else should I consider?

You may be worried about having an organ transplant, being in a transplant center 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 directive on file with the transplant center or hospital where you will receive care. An advance directive provides instructions about your medical choices should you be unable to make those choices for yourself. It is a good idea to appoint a health care agent to make your health decisions if you are unable to communicate your wishes. For more information, see the topics Writing an Advance Directive and Choosing a Health Care Agent.

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.