available, specific for each kind of organ, so a
waiting recipient may appear on several lists and
in different rankings relative to others on the
same list.
The available organ goes to the waiting recipi-
ent who is the best match on as many criteria as
possible. For organs such as the HEARTand LUNGS,
geographic proximity is a critical factor because
the window of opportunity for transplantation is
so short. Body size may be important for organs
such as the liver, heart, and lungs. Typically gen-
der and ethnicity or race are not factors for vascu-
larized organ transplants unless they influence
body size. Financial status is not a consideration
under any circumstances. Living donor transplants
are not subject to OPTN/UNOS procedures but
rather are coordinated privately between the
donor and the recipient.
Organ Transplantation SurgeryTransplantation of vascularized (solid) organs is
major surgery that may require the organ recipi-
ent to be prepared for surgery within hours of
notification that an organ is available. Time is
especially critical for heart, lung, and heart–lung
transplantation. In most transplant operations the
surgeon transplants a single organ. Combination
transplantations are becoming more common,
however, with surgeons transplanting together
heart and lung, SMALL INTESTINEand liver, or kid-
ney and pancreas. The operation to transplant a
single organ may take three to five hours; combi-
nation transplants may take longer. The transplant
recipient may remain hospitalized for several
weeks after surgery, depending on the organ, rate
of recovery, and overall health status.
With some organs, such as kidneys, the sur-
geon can leave the native organ in place and
transplant the donor organ in an adjacent loca-
tion. This is a heterotopic transplant. The surgeon
may also choose to remove the recipient’s native,
diseased organ and transplant the donor organ in
its place, such as the liver. This is an orthotopic
transplant. One approach is not necessarily easier
or more effective than the other for either the sur-
geon or the recipient. Circumstances that shape
the decision include the recipient’s general health
status, anatomic characteristics, and the organ
being transplanted.
Life after Transplantation
The course of recovery after transplantation varies
with the organ transplanted, age, and overall
health circumstances. Most organ transplant recip-
ients are able to return to previous work, recre-
ational, and lifestyle activities they enjoyed before
experiencing the health circumstances that made
their transplants necessary, usually within two to
three months. Transplant recipients do require
ongoing medical assessment and care, which may
consist of doctor visits every few weeks for the
first 6 to 12 months after the transplant and every
6 to 12 months indefinitely, depending on the
organ transplanted and general health status.
The key health risks after transplantation are
primary organ failure and organ rejection. Primary
organ failure occurs when the organ does not
function after transplantation. The organ may
start to function and then stop or may never begin
functioning. Some organs, such as the kidneys,
may take several weeks to several months to start
functioning or to function normally, which is the
usual course of events for them and does not nec-
essarily indicate that the transplant has failed. It is
not unheard of for a kidney transplant recipient to
require renal hemodialysis after the transplant
OPERATION, and hemodialysis remains a therapeutic
option when a transplanted kidney does fail. Pri-
mary organ failure of the heart, lungs, or liver is a
medical emergency that requires retransplantation
as soon as possible. Numerous and often collusive
factors may account for primary organ failure of a
transplant.
Organ rejection occurs when the recipient’s
IMMUNE SYSTEMproduces antibodies that attack the
transplanted organ and is a process rather than an
event. Every transplant experiences rejection to
some degree because rejection represents the
body’s natural IMMUNE RESPONSE. Organ rejection
may be acute or chronic. Acute rejection develops
rapidly and may present symptoms similar to a
viral INFECTIONsuch as the flu, though often there
is tenderness or PAINat the site of the transplant.
Acute rejection requires immediate medical treat-
ment with immunosuppressive agents to attempt
to subdue the immune response and minimize
damage to the organ. Episodes of acute rejection
are common in the first year after transplantation
and can occur months to years later. A singleorgan transplantation 271