Organ Transplants

An organ transplant is performed when a critical organ of the body is functioning poorly and is headed towards complete failure. Organ failure can cause the death of a person. To prevent this, doctors suggest a transplant as the end measure, wherein a healthy organ from a living or deceased person is transplanted into the recipient of the organ transplant.
The organ transplant procedure is complex and delicate & requires a highly skilled team of surgeons. Finding a matching donor is another crucial part of the organ transplant process.
Once it is determined that the patient has to undergo the transplant procedure, they are placed on a waiting list for a donor organ. Patients who have cancer, hepatitis, or cardiovascular disease, are not considered ideal candidates for the organ transplant process.

Kidney Transplant

Kidneys are essential organs that help filter toxins from the blood and maintain electrolyte balance. This is necessary for the body to function normally.
Kidneys remove excess fluid and waste from the blood. When they lose their filtering ability, high levels of fluid and waste accumulate in the body, leading to kidney failure. Kidney failure can be contained by dialysis. However, dialysis is ruled out in some patients due to their health condition or the severity of the kidney failure. For such patients, one or both kidneys may be replaced.
In the case of a single kidney transplant, usually, a family member with the same blood group comes forward as the donor of the organ, which reduces the chances of organ rejection after the transplant. Both donor and recipient are put on a special diet and medication to lessen the chances of complications such as blood infection or rejection of the donor organ.

Types of kidney disease:

Acute kidney injury- kidney problems that occur quickly, especially when the kidney has been injured in an accident. Losing a lot of blood can cause renal failure. Some drugs or poison can stop the kidney from functioning. This sudden drop in kidney function is called acute kidney injury or acute renal failure. It may lead to permanent loss of kidney function but may be reversed if kidneys are not seriously damaged.
Chronic kidney disease: Most kidney problems happen slowly. This gradual loss of kidney function is called chronic kidney disease or chronic renal insufficiency. This may lead to permanent kidney failure.
End-stage renal disease: Total or nearly total & permanent kidney failure is referred to as an end-stage renal disease. The only solution to this is dialysis or transplantation.
Signs & symptoms of chronic kidney disease:
In the early stages of kidney disease, people don’t feel sick. These symptoms may only appear when the kidney disease has gotten worse.
  • Group 2167 Need to urinate more frequently or less
  • Group 2168 Feeling tired
  • Group 2169 Loss of appetite
  • Group 2178 Nausea or vomiting
  • Group 2171 Muscle cramp
  • Group 2175 Swelling in hand or feet
  • Group 2172 Itchiness or numbness
  • Group 2173 Feeling drowsy
  • Group 2174 Darkened skin
Detecting chronic kidney disease (CKD)
The doctor first detects the condition through routine urine and blood tests. recommended by the National Kidney Foundation recommends the following tests – a blood pressure measurement, a spot check for protein or albumin in the urine, and a calculation of glomerular filtration rate (GFR) based on a serum creatinine measurement. Measuring urea nitrogen in the blood provides additional information.

Preparing for end-stage renal disease

People in the later stages of CKD need to understand their options for treating the last stages of kidney failure so they can make an informed choice between hemodialysis, peritoneal dialysis, and transplantation.
Total or nearly total and permanent kidney failure is called ESRD. If a person’s kidneys stop working completely, the body fills with extra water and waste products. This condition is called uremia. Hands or feet may swell. A person will feel tired and weak because the body needs clean blood to function properly. Untreated uremia may lead to seizures or coma and will ultimately result in death. A person whose kidneys stop working completely will need to undergo dialysis or kidney transplantation.

Dialysis

Two major forms of dialysis are hemodialysis and peritoneal dialysis.
Hemodialysis uses a special filter called a dialyzer that functions as an artificial kidney to clean a person’s blood. The dialyzer is a canister connected to the hemodialysis machine. During treatment, the blood travels through tubes into the dialyzer, which filters out wastes, extra salt, and extra water. Then the cleaned blood flows through another set of tubes back into the body. The hemodialysis machine monitors blood flow and removes wastes from the dialyzer. Hemodialysis is usually performed at a dialysis center three times per week for 3 to 4 hours.
In peritoneal dialysis, a fluid called dialysis solution is put into the abdomen. This fluid captures the waste products from a person’s blood. After a few hours when the fluid is nearly saturated with wastes, the fluid is drained through a catheter. Then, a fresh bag of fluid is dripped into the abdomen to continue the cleansing process. Patients can perform peritoneal dialysis themselves. Patients using continuous ambulatory peritoneal dialysis (CAPD) change fluid four times a day. Another form of peritoneal dialysis, called continuous cycling peritoneal dialysis (CCPD), can be performed at night with a machine that drains and refills the abdomen automatically.

Undergoing a Kidney Transplant

A kidney transplant is done by placing a kidney from a live or deceased donor into a person whose kidneys no longer function properly.
Only one donated kidney is needed to replace two failed kidneys, which means that compatible persons can donate one of their kidneys safely. Laparoscopy is usually used to remove the donor’s kidney. Advantages include less pain, shorter hospital stay, a more rapid return to normal activities, and a smaller, less noticeable scar.
The new kidney is placed in the lower abdomen. Unless existing kidneys are causing complications such as high blood pressure, kidney stones, pain, or infection, they are left in place. The blood vessels of the new kidney are attached to blood vessels in the lower part of the abdomen. The new kidney’s ureter is connected to the urinary bladder. Kidney transplant surgery usually lasts about three to four hours.

After the Kidney Transplant

After a successful kidney transplant, the new kidney will filter blood and also start producing urine. To prevent the body from rejecting the new kidney, medications to suppress the immune system will have to be taken lifelong.

Why some people prefer kidney transplants

Most patients say that getting a kidney transplant improves the quality of their lives. They feel better and have more energy to spend time with their family, pursue hobbies, travel, and go back to work. Patients also say they have more time – time that would have been spent on dialysis treatments. Kidney transplant patients generally have a longer life expectancy than those patients who stay on dialysis.

Liver Transplant

The liver is an unusually resilient and vital organ that plays an essential role in nurturing and protecting our body every day. It performs several key functions like– helping filter and disposing off toxic materials from the blood, feeding the body the energy it needs to function, warding off viruses and infections, producing blood-clotting factors, regulating sex hormones, cholesterol levels, and vitamin and mineral supplies in the body. In addition to these, the liver performs over 500 functions, far more than any other organ in our body!
The liver plays a critical role in sustaining complete health and supports almost every organ in the body, hence is vital for survival. Currently, there is no artificial organ or device capable of emulating all the functions of the liver.
In case of liver disease that can’t be cured, the patient’s unhealthy liver is replaced with either a portion of liver from a living donor or the entire healthy liver from a deceased donor.

Conditions of the Liver

Liver disease can prevent the liver from performing its numerous vital functions. There are many kinds of liver diseases. Some common diseases of the liver like Hepatitis A, Hepatitis B, and Hepatitis C are caused by viruses that attack the liver. Still, other liver diseases can be the result of drug abuse, exposure to poisons, or excessive consumption of alcohol.
Hepatitis a causes inflammation of the liver and is primarily transmitted through contamination of food or drinking water with fecal matter. It can be effectively prevented by vaccine shots and sanitary precautions.
Hepatitis B is another infection of the liver, primarily spread through blood or body fluid contact with an infected person. It is easily prevented with vaccination and by avoiding unprotected sex, contaminated needles, and similar sources of infection.
Hepatitis C is spread by direct contact with infected blood and blood products. Currently, there is no effective vaccine that affords protection against Hepatitis C.
Cirrhosis damages healthy liver cells and replaces them with scar tissue, preventing the liver from functioning efficiently.
Liver cancer, caused by an abnormal multiplication of cells can result from diseases such as Hepatitis B and C, alcohol abuse, exposure to chemicals, or congenital defects.
Liver failure is a potentially life-threatening condition characterized by severe deterioration of liver function as a result of extensive damage to the liver.
Treatment of all liver diseases involves immediate medical care aimed at slowing the progression of the disease, minimizing the symptoms, and reducing further complications.

Performing Liver Transplant

Liver transplantation is surgery that is performed to remove a diseased liver in order to replace it with a healthy one.
A liver transplant is usually suggested in case of end-stage liver disease. Cirrhosis of the liver due to alcohol abuse is the most common reason for a liver transplant. The success rate for liver transplants is very high.
Evaluations by specialists from a variety of fields are needed to determine if a liver transplant is appropriate. The evaluation includes a review of your medical history and a variety of tests. The transplant team will arrange blood tests, X – rays, and other tests to help make the decision about whether you need a transplant and whether a transplant can be carried out safely. Other aspects of your health-like your heart, lungs, kidneys, immune system, and mental health will also be checked to be sure you’re strong enough for surgery.
You cant have a liver transplant if you have:
Time taken to get a liver transplant
If you are eligible and decide to go for a liver transplant, your name will be placed on a waiting list. Patients are listed according to blood type, body size, and medical condition (how ill they are). Each patient is given a priority score based on three simple blood tests (creatinine, bilirubin, and INR). The score is known as the MELD (model of end-stage liver disease) score in adults and PELD (pediatric end-stage liver disease) in children.
Patients with the highest scores are transplanted first. As they become more ill, their scores will increase, and therefore their priority for transplant increases, allowing for the sickest patients to be transplanted first.
There are two types of liver transplant options: living donor transplant and deceased donor transplant.
Living donor liver transplants are an option for some patients with end-stage liver disease. This involves removing a segment of liver from a healthy living donor and implanting it into a recipient. Both the donor and recipient liver segments will grow to normal size in a few weeks.
The donor, who may be a blood relative, spouse, or friend, will have extensive medical and psychological evaluations to ensure the lowest possible risk. Blood type and body size are critical factors in determining who is an appropriate donor. All living donors and donated livers are tested before transplant surgery. The testing makes sure the liver is healthy, matches your blood type, and is the right size so it has the best chance of working in your body.
Recipients for the living donor transplant must be active on the transplant waiting list. Their health must also be stable enough to undergo transplantation with excellent chances of success.
In a deceased donor liver transplant, the donor may be a victim of an accident, brain hemorrhage, or head injury. The donor’s heart is still beating, but the brain has stopped functioning. Such a person is considered legally dead because his or her brain has permanently and irreversibly stopped working. At this point, the donor is usually in an intensive-care unit. The liver is donated, with the consent of the next of kin, from such individuals. Whole livers come from people who have just died. This type of donor is called a cadaveric donor. The identity of a deceased donor and circumstances surrounding the person’s death are kept confidential.
During the Liver Transplant Surgery
Liver transplants usually take from 4 to 14 hours. During the operation, surgeons will remove your liver and will replace it with the donor’s liver. The surgeon will disconnect your diseased liver from your bile ducts and blood vessels before removing it. The blood that flows into your liver will be blocked or sent through a machine to return to the rest of your body. The surgeon will put the healthy liver in place and reconnect it to your bile ducts and blood vessels. Your blood will then flow into your new liver. Because a transplant operation is a major procedure, surgeons will need to place several tubes in your body. These tubes are necessary to help your body carry out certain functions during the operation and for a few days afterward.
Recovery Post Surgery
Initially, in the intensive care unit, there is constant monitoring of all body functions of the patient, including the liver. Once the patient is transferred to the ward, the frequency of blood testing, etc. is decreased, eating is allowed and physiotherapy is prescribed to regain muscle strength. The medications to prevent rejection are first given by vein, and later by mouth. During the transplantation, frequent tests are performed to monitor liver function and detect any evidence of rejection.
Rejection
When the liver is transplanted from one person (the donor) into another (the recipient), the immune system of the recipient triggers the same response against the new organ that it would have against any foreign material, setting off a chain of events that can damage the transplanted organ. This process is called rejection. Rejection can occur despite close matching of the donated organ and the transplant patient.
Your body’s immune system works to destroy foreign substances that invade your body. The immune system cannot distinguish between your transplanted liver and unwanted invaders, such as viruses and bacteria. Therefore, your immune system may attempt to attack and destroy your new liver. This is called a rejection episode. About 70% of all liver-transplant patients have some degree of organ rejection prior to discharge. Anti-rejection medications are given to ward off the immune attack.
Preventing Rejection
After the liver transplant, you will receive medications called immunosuppressants. Immunosuppressants weaken your immune system’s ability to reject your new liver. These medications slow or suppress your immune system to prevent it from rejecting your new liver. Immunosuppressant drugs greatly decrease the risks of rejection, protecting the new organ and preserving its function. These drugs act by blocking the recipient’s immune system so that it is less likely to react against the transplanted organ.
Side effects of immunosuppressants
Immunosuppressant drugs lower a person’s resistance to infection and can make infections harder to treat. Although these medications are meant to prevent rejection of the liver, they also decrease the ability of the body to fight off certain viruses, bacteria, and fungi. The organisms that most commonly affect patients are covered with preventive medications. However, avoiding contact with people who have infections is very important.
Duration of the Medication
Usually, medication has to be taken lifelong. When the body adjusts to the transplanted liver, the amount of medication can be reduced.
Symptoms of Rejection
  • Group 2187 Fever greater than 100° F
  • Group 2188 Fatigue or excess sleepiness
  • Group 2194 Crankiness
  • Group 2186 Headache
  • Group 2185 Abdominal swelling, tenderness, or pain
  • Group 2189 Decreased appetite
  • Group 2190 Jaundice (yellow skin or eyes)
  • Group 2191 Dark (brown) urine
  • Group 2192 Itching
  • Group 2193 Nausea
They may not be specific to rejection but must be reported and investigated immediately. Regular blood tests also help monitor the situation.
Post-Transplant Care
After discharge, you need to visit your doctor regularly to ensure that your new liver is working well. You will also need to have regular blood tests to check that your new liver is not being damaged by rejection, infections, or problems with blood vessels or bile ducts. You will need to be careful about avoiding sick people and must immediately report any signs of illness to your doctor. Home care involves building up endurance to carry out daily life activities and recovering to the level of health that the patient had before surgery. This can be a long, slow process that includes simple activities. Walking may require assistance at first. Coughing and deep breathing are very important to help the lungs stay healthy and to prevent pneumonia. Diet may at first consist of ice chips, then clear liquids, and, finally, solids. It is important to eat well-balanced meals with all food groups. After about 3-6 months, a person may return to work if he or she feels ready and it is approved by the doctor. Besides a healthy diet and exercise, you must abstain from alcohol, especially if alcohol was the primary cause of damage to your own liver. Before you take any medication, including ones you can buy without a prescription, you will need to check with your doctor whether it is safe for you. It is most important to diligently follow your doctor’s instructions to take good care of your new liver.

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