Organ Transplant

Background

Organ transplantation is the surgical removal of an organ or tissues from one person, which is placed into another person. This is often necessary when a person’s organ stops working. Each day, about 75 people receive organ transplants. The heart, kidney, liver and lung are the most common organ transplants that people receive.

Heart transplants are done as a life-saving measure for people with end-stage heart failure when medications and less drastic surgery have failed. Heart failure is a condition when the heart can’t pump enough blood to meet the body’s needs. Kidney transplants are necessary to replace the work of kidneys that have failed. When a person has kidney failure, harmful wastes can build up in the body, blood pressure may rise and the body may retain too much fluid. Often times, people with either acute or chronic liver failure may need a liver transplant. Acute liver failure happens suddenly. It is often caused by taking too much of certain medications, such as acetaminophen (Tylenol). Chronic liver failure may develop over months or years as a result of cirrhosis. Lung transplants are used for people whose condition is so severe that other treatments, such as medicines or breathing devices, no longer work.

Causes

Depending on the organ, there are certain reasons why it may stop working properly:

Heart
There are certain conditions that either damage or overwork the heart muscle and lead to heart failure. These conditions can include coronary heart disease (CHD), high blood pressure and diabetes.
Kidney
Diabetes and high blood pressure damage the blood vessels in the kidneys, which can cause kidney failure.
Liver
The most common reason adults require a liver transplant is because they develop cirrhosis. Chronic hepatitis C infection and long-term alcohol abuse are the most common causes of cirrhosis. This is a condition when scar tissue replaces healthy tissue in the liver until it can no longer function.
Lung
Lung transplants are used most often to treat people who have severe:
COPD (chronic obstructive pulmonary disease)
COPD is the most common reason why adults need lung transplants. COPD is a disease that develops over time and makes it hard for a person to breathe.
Idiopathic pulmonary fibrosis (IPF)
IPF is a condition in which tissue deep in the lungs becomes thick and stiff, or scarred, over time.
Cystic fibrosis (CF)
CF is the most common reason for lung transplants in children. CF is an inherited disease that causes thick, sticky mucus to build up in the lungs. This leads to repeated, serious lung infections.
Alpha-1 antitrypsin deficiency (AAT deficiency)
AAT deficiency is a condition that raises the risk of a person developing certain types of lung disease. This risk is highest in people who smoke.
Pulmonary hypertension (PH)
PH is increased pressure in the pulmonary arteries. These arteries carry blood from the heart to the lungs to pick up oxygen.

Symptoms

There are different types of symptoms listed below that people may have, depending on the organ that is no longer working properly:

Heart
The most common symptoms of heart failure are shortness of breath or trouble breathing, fatigue, and swelling in the ankles, feet, legs, abdomen or veins in the neck.
Kidney
Some people may lose their appetite, experience fatigue or have leg cramps. These symptoms can develop because waste products that the kidney normally eliminates from the body build up in the blood. Other common symptoms of kidney failure are itching, sleep problems, restless legs, weak bones, joint problems and depression.
Liver
Symptoms of liver failure may include jaundice (a condition that causes yellowing of the skin and the whites of the eyes), fatigue, weakness, loss of appetite, muscle loss and bruising or bleeding easily.
Lung
Symptoms of respiratory failure may include shortness of breath, rapid breathing, confusion, sleepiness and a bluish color of the skin, lips and fingernails.

Diagnosis

Organ transplantation is the last option to treat people when medications or devices are no longer helpful. A doctor will determine if a patient requires an organ transplant based on medical and family histories, physical exam, whether the patient is healthy enough to receive a new organ and the results of certain lab tests.

Treatment

Specialty drug list

Transplantation is not a cure. It’s an ongoing treatment that requires a person to take medicines for the rest of their life. A person’s immune system is designed to keep their body healthy by sensing foreign invaders such as bacteria and rejecting them. The body’s immune system often thinks a new organ is a foreign invader and starts to attack it. In order to keep the body from rejecting the new organ, people need to take drugs to turn off, or suppress, the immune response. These medications are called immunosuppressants.

Side Effects

Immunosuppressants weaken the immune system by affecting the ability of immune cells to function. This can lead to an increased risk of a person developing an infection. Other side effects of immunosuppressants may include:

  • Weight gain
  • Acne
  • Cataracts
  • Diabetes
  • Extra stomach acid
  • High blood pressure

Sometimes side effects can disrupt a person’s life and day-to-day activities, but it is important that a person never change their dosage or stop taking their medication without talking to their doctor or pharmacist.

Resources

There are many resources and organizations available to help, providing support, advocacy and information:

American Heart Association

National Kidney Foundation

American Liver Foundation

American Lung Association

References

U.S Department of Health & Human Services. http://organdonor.gov/about/data.html. Accessed December 12, 2011.

National Institutes of Health. NHLBI. http://www.nhlbi.nih.gov/health/health-topics/topics/ht/. Accessed December 15, 2011.

National Institutes of Health. NHLBI. http://www.nhlbi.nih.gov/health/health-topics/topics/hf/. Accessed December 19, 2011.

National Institutes of Health. NIDDK. Handout on Kidney Failure: What to Expect. NIH Publication No. 12-6059. December 2011.

National Institutes of Health. NIDDK. Handout on Treatment Methods for Kidney Failure Transplantation. NIH Publication No. 06-4687. May 2006.

National Institutes of Health. NKDEP. http://www.nkdep.nih.gov/patients/kidney_disease_information.htm. Accessed December 21, 2011.

National Institutes of Health. NIDDK. Handout on Liver Transplantation. NIH Publication No. 10-4637. June 2010.

National Institutes of Health. NHLBI. http://www.nhlbi.nih.gov/health/health-topics/topics/lungtxp/. Accessed December 12, 2011.