Transplantation is a medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ.

Bone Marrow Transplant
Q. What is a bone marrow transplant?
A: A bone marrow transplant is a treatment that replaces unhealthy marrow with a healthy one. It’s also called a blood or marrow transplant (BMT).

Q. What is bone marrow?
A: Bone marrow is the soft, spongy tissue inside your bones that makes blood-forming cells (blood stem cells). 

These cells turn into blood cells including:
- White blood cells to fight infections.
- Red blood cells to carry oxygen throughout the body.
- Platelets to control bleeding.
- Blood-forming cells are also found in the blood stream and the umbilical cord blood.

Q. How does transplant work?
A: Before transplant, you get chemotherapy (chemo) with or without radiation to destroy the diseased blood-forming cells and marrow. Then, healthy cells are given to you (it’s not surgery). The new cells go into your bloodstream through an intravenous (IV) line, or tube. It’s just like getting blood or medicine through an IV. The cells find their way into your marrow, where they grow and start to make healthy red blood cells, white blood cells and platelets.

Q. What diseases can BMT treat?
A: Bone marrow transplants can treat:
Blood cancers like leukemia or lymphoma
Bone marrow diseases like aplastic anemia
Other immune system or genetic diseases like sickle cell disease

3 common types of BMT:

• Haploidentical transplant – a type of allogeneic transplant
• Autologous transplant – uses your own blood-forming cells
• Allogeneic transplant – uses blood-forming cells donated by someone else
   

Corneal Transplant
Cornea transplant is a procedure that replaces your cornea, the clear front layer of your eye. During this procedure, your surgeon removes damaged or diseased corneal tissue. Healthy corneal tissue from the eye of a deceased human donor replaces the damaged cornea. For many people, cornea transplant surgery restores clear vision and improves their quality of life. Symptoms may indicate a cornea transplant
If you have a damaged cornea, you may experience symptoms including:
- Eye pain
- Blurred vision
- Cloudy vision
Your ophthalmologist will determine the cause and other possible treatments that may resolve these symptoms. If your cornea cannot be repaired using other methods, your surgeon may recommend a cornea transplant.

Heart Transplant
Q. What is a heart transplant?
A: A heart transplant is surgery to remove the diseased heart from a person and replace it with a healthy one from an organ donor. To remove the heart from the donor, two or more healthcare providers must declare the donor brain-dead.

Before you can be put on a waiting list for a heart transplant, a healthcare provider makes the decision that this is the best treatment choice for your heart failure. A healthcare team also makes sure you are otherwise healthy enough to go through the transplant process.

Q:Why might I need a heart transplant?
A:You may need a heart transplant if your heart is failing and other treatments are not effective.

End-stage heart failure is a disease in which the heart muscle is failing severely in its attempt to pump blood through the body. It means other treatments are no longer working. End-stage heart failure is the final stage of heart failure. Despite its name, a diagnosis of heart failure does not mean the heart is about to stop beating. The term failure means the heart muscle is failing to pump blood normally because it is damaged or very weak, or both.

Some causes of heart failure include:

• Heart attack (myocardial infarction or MI)
• Viral infection of the heart muscle
• High blood pressure
• Heart valve disease
• Heart defects present at birth (congenital)
• Irregular heartbeats ( arrhythmias )
• High blood pressure in the lungs ( pulmonary hypertension )
• Alcoholism or drug abuse
• Chronic lung diseases, such as emphysema or chronic obstructive pulmonary disease (COPD)
• Heart muscle is enlarged, thick, and stiff ( cardiomyopathy )
• Low red blood cell count ( anemia )

Your healthcare provider may have other reasons to recommend a heart transplant.

Q: What are the risks of a heart transplant?
A: As with any surgery, complications may occur. Potential risks of a heart transplant may include:

• Infection
• Bleeding during or after the surgery
• Blood clots that can cause heart attack, stroke, or lung problems
• Breathing problems
• Kidney failure

Coronary allograft vasculopathy (CAV). This is a problem with the blood vessels that carry blood to the heart muscle itself. They become thick and hard. This can cause serious heart muscle damage.

Failure of the donor heart

• Death

Your bodys immune system may reject the new heart. Rejection is your bodys normal reaction to a foreign object or tissue. When you get a new heart, your immune system reacts to what it sees as a foreign threat and attacks the new organ. To allow the transplanted organ to survive in a new body, you will need to take medicines. The medicines will trick the immune system into accepting the transplant and keep it from attacking it.

You will need to take the medicines to prevent or treat rejection for the rest of your life. These drugs have side effects too. The side effects will depend on the specific medicines you take. Current or repeated infection that does not get better with treatment. Poor blood circulation throughout the body, including the brain Metastatic cancer. This is when cancer has spread from the place it started to one or more other places in the body. Severe health problems that would make you unable to tolerate the surgery. Serious health problems other than heart disease that would not get better after transplant. Noncompliance with treatment regimen. For instance, not following your healthcare providers directions, not taking medicines as prescribed, or missing appointments. Drug or alcohol abuse

There may be other risks depending on your specific health condition. Be sure to discuss any concerns with your healthcare provider before the surgery.

Q:How do I get ready for a heart transplant?
Not everyone is a candidate for heart transplant. Because of the wide range of information needed to know if a person is eligible for transplant, a transplant team will review the evaluation. The team includes a transplant surgeon, a transplant cardiologist (doctor specializing in the treatment of the heart), nurse practitioners or physician assistants, one or more transplant nurses, a social worker, and a psychiatrist or psychologist. Other team members may include a dietitian, a chaplain, hospital administrator, and an anesthesiologist (doctor who uses medicines to keep you asleep during
surgery).

The transplant evaluation process will include:

• Psychological and social evaluation. Some psychological and social issues that are involved in organ transplant include stress, financial issues, and support from family or significant others. These factors can greatly affect how you do after the transplant.
• Blood tests. You will need blood tests to help find a good donor match and help improve the chances that the donor heart will not be rejected.
• Diagnostic tests. You will need tests to assess your lungs as well as your overall health. These tests may include X-rays, ultrasound procedures, CT scan, pulmonary function tests (PFTs), and dental exams. Women may get a Pap test, gynecology evaluation, and a mammogram.

Other preparations. You will get several vaccines to decrease the chances of developing infections that can affect the transplanted heart.

The transplant team will consider all the information from interviews, your health history, the findings from your physical exam, and your diagnostic test results when deciding if you are eligible for a heart transplant.

Once you have been accepted as a transplant candidate, you will be placed on the United Network for Organ Sharing list. When a donor organ becomes available, candidates are selected based on the severity of their condition, body size, and blood type. If the heart is to be yours, you will need to go to the hospital right away so you can get ready for the transplant. (Most hearts must be transplanted within 4 hours after they’ve been removed from the donor.)

These things will need to be done before the transplant:

• Your healthcare provider will explain the procedure and let you ask questions.
• You will be asked to sign a consent form that gives your permission to do the surgery.
• Read the form carefully and ask questions if anything is unclear.
• You should not eat or drink anything (fast) as soon as you have been told that a heart has become available.
• You may be given medicine to help you relax (sedative).

Based on your health condition, your healthcare provider may request other specific preparation.

Q: What happens during a heart transplant?
A :heart transplant requires open heart surgery and a stay in a hospital. Procedures may vary depending on your condition and your healthcare providers practice.

Generally, a heart transplant follows this process:

• You will be asked to remove any jewelry or other objects that may interfere with the procedure.
• You will change into a hospital gown.
• A healthcare professional will start an intravenous (IV) line in your hand or arm to inject medicine and to give IV fluids. Additional catheters will be put in blood vessels in your neck and wrist to monitor the status of your heart and blood pressure, and to take blood samples.
• Other sites for the additional catheters include the under the collarbone and the groin.
• A soft, flexible tube (Foley catheter) will be put into your bladder to drain urine.
• A tube will be put through your mouth or nose into your stomach to drain stomach fluids.
• If there is a lot of hair on your chest, it may be shaved.
• Heart transplant surgery will be done while you are in a deep asleep (under general anesthesia). Once you are asleep, a breathing tube will be put through your mouth into your lungs. The tube will be attached to a machine (ventilator) that will breathe for you during the surgery.
• The anesthesiologist will watch your heart rate, blood pressure, and blood oxygen level during the
  surgery.
• The skin over your chest will be cleaned with an antiseptic solution.
• The surgeon will make a cut (incision) down the center of your chest from just below the Adams apple to just above the navel.
• The surgeon will cut the breastbone (sternum) in half. He or she will separate the two halves of the breastbone and spread them apart to reach your heart.
• The surgeon will put tubes into your chest so that your blood can be pumped through your body by a heart-lung (cardiopulmonary bypass) machine while your heart is stopped and replaced.
• Once the blood has been completely diverted into the bypass machine and is being pumped by the machine, your doctor will remove the diseased heart.
• The surgeon will sew the donor heart into place. Once your new heart is in place, he or she will connect the blood vessels carefully so there are no leaks.
• When your new heart is fully connected, the blood circulating through the bypass machine will be allowed back into the heart and the tubes to the machine are removed.
• Your surgeon will shock the heart with small paddles to restart the heartbeat.
• Once your new heart starts to beat, the healthcare team will watch the heart to see how it’s working and make sure there are no leaks.
• Wires for pacing may be put into the heart. Your surgeon can attach these wires to a pacemaker outside your body for a short time to pace your new heart, if needed, during the initial recovery period.
• The surgeon will rejoin the sternum and sew it together with small wires.
• The surgeon will sew the skin over the sternum back together. He or she will use sutures or surgical staples to close the incision.

Tubes will be put into your chest to drain blood and other fluids from around the heart. These tubes ill be connected to a suction device to drain fluids away from the heart as it heals.

Q: What happens after a heart transplant?

In the hospital
After the surgery, someone will take you to the recovery room or the intensive care unit (ICU) and monitor you closely for several days. A nurse will connect you to machines that will display your electrocardiogram (ECG) tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level. Heart transplant surgery requires a hospital stay of 7 to 14 days, or even longer.

You will have a tube in your throat that connects to a breathing machine (ventilator) until you are stable enough to breathe on your own. The breathing tube may stay in for a few hours up to several days, depending on your case. As you recover and start to breathe on your own, the breathing
machine will be adjusted to allow you to take over more of the breathing. When you are able to breathe completely on your own and are able to cough, your doctor will remove the breathing tube.

After the breathing tube is out, a nurse will help you cough and take deep breaths every 2 hours. This will be uncomfortable due to soreness, but it is extremely important that you do this to keep mucus from collecting in your lungs and possibly causing pneumonia. Your nurse will show you how to hug a pillow tightly against your chest while coughing to help ease the discomfort.

You may get pain medicine as needed, either by a nurse, or by giving it yourself by pushing a button attached to a device connected to your IV line.

You may have a thin, plastic tube that goes through your nose and into your stomach to remove air that you swallow. The tube will be taken out when your bowels are working normally. You will not be able to eat or drink until the tube is removed.

Blood samples will be taken often to monitor your new heart, as well as other body functions. These include your lungs, kidneys, liver, and blood system.

You may be on special IV medicines to help your blood pressure and your heart, and to control any problems with bleeding. As your condition stabilizes, your doctor will gradually decrease, then stop, these medicines. If you have pacing wires in your heart, he or she will remove those too.

Once your doctor removes the breathing and stomach tubes and you are stable, you may start to drink liquids. You can gradually add more solid foods as you can handle them.

Your healthcare team will closely watch your anti-rejection (immunosuppression) medicines to make sure you are getting the right dose and the best combination of medicines.

Nurses, respiratory therapists, and physical therapists will work with you as you begin physical therapy and breathing exercises.

When your healthcare provider decides you are ready, you will be moved from the ICU to a private room on a surgical unit or transplant unit. Your recovery will continue there. You can gradually increase your activity as you get out of bed and walk around for longer periods. You can eat solid foods as tolerated.

Nurses, pharmacists, dietitians, physical therapists, and other members of the transplant team will teach you what you will need to do to take care of yourself when you go home.

Your healthcare team will arrange for you to go home and schedule a follow-up visit with your healthcare provider.

At home

Once you are home, it will be important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. During a follow-up visit, your doctor will remove the sutures or surgical staples, if they were not removed before leaving the hospital. Do not drive until your healthcare provider tells you its OK. Other activity restrictions may apply.

You will need frequent follow-up visits after transplant. These visits may include blood tests, chest X- rays, and biopsy. In a biopsy, your doctor uses a thin needle to remove tissue from the heart so he or she can examine it under a microscope. The transplant team will explain the schedule for these visits and tests. The rehab program will continue for many months.

Tell your healthcare provider right away if you have any of the following:

• Fever, chills, or both. These may be a sign of infection or rejection.
• Redness, swelling, bleeding, or drainage from the incision site or any of the catheter sites
• Increase in pain around the incision site
• Trouble breathing
• Excessive fatigue
• Low blood pressure

Your healthcare provider may give you other instructions after the procedure, depending on yourown case.

To allow the transplanted heart to survive in your body, you will need to take medicines for the rest of your life to fight rejection. Each person may react differently to medicines, and side effects can be serious. Your healthcare provider will tailor medicine plans to meet your needs.

You may get several anti-rejection medicines at first. The doses of these medicines may change often, depending on your response. Because anti-rejection medicines affect the immune system, you will be at higher risk for infections. Its important to keep a balance between preventing rejection and making you very susceptible to infection.

Some of the infections you will be especially susceptible to include oral yeast infection (thrush), herpes , and respiratory viruses. You should avoid contact with crowds and anyone who has an infection for the first few months after your surgery.

Regular dental care also is important. Your healthcare provider or dentist may prescribe antibiotics before any dental work to help prevent infections.

To watch for signs of rejection, you will likely get routine right heart biopsies. A biopsy is typically done once a week in the early period after a transplant, then gradually changed to monthly or longer intervals. The biopsy procedures may eventually stop.

The right heart biopsy procedure may be done as an outpatient or as an inpatient if you are already in the hospital. The procedure involves a right heart catheterization. A special catheter is threaded through a vein in your neck or groin and into the right atrium of your heart. Your doctor takes 4 to 6 tiny tissue samples through the catheter and checks them for signs of rejection. If your doctor finds signs of rejection, he or she may adjust your anti-rejection medicine. The biopsy procedure has its own instructions and risks, and your healthcare provider will discuss these with you.

Kidney Transplant
What is a kidney transplant?
A kidney transplant is a surgery done to replace a diseased kidney with a healthy
kidney from a donor. The kidney may come from a deceased organ donor or from a
living donor. Family members or others who are a good match may be able to
donate one of their kidneys. This type of transplant is called a living transplant.
People who donate a kidney can live healthy lives with one healthy kidney.
A person getting a transplant most often gets just 1 kidney. In rare situations, he or
she may get 2 kidneys from a deceased donor. The diseased kidneys are usually left
in place. The transplanted kidney is placed in the lower belly on the front side of the
body.

Why might I need a kidney transplant?
You may need a kidney transplant if you have end stage renal disease (ESRD). This
is a permanent condition of kidney failure. It often needs dialysis. This is a process
used to remove wastes and other substances from the blood.
The kidneys:

•  Remove urea and liquid waste from the blood in the form of urine. Urea is
  made when foods containing protein, such as meat, poultry, and certain
  vegetables, are broken down in the body. Urea is carried in the blood to the
  kidneys.
• Balance salts, electrolytes, such as potassium and sodium, and other
  substances in the blood
• Produce erythropoietin, a hormone that aids the formation of red blood cells
• Regulate blood pressure
• Regulate fluid and acid-base balance in the body to keep it neutral. This is
  needed for normal function of many processes within the body
  Some conditions of the kidneys that may result in ESRD include:
• Repeated urinary infections
• Kidney failure caused by diabetes or high blood pressure
• Polycystic kidney disease or other inherited disorders
• Glomerulonephritis, which is inflammation of the kidneys filtering units
• Hemolytic uremic syndrome, a rare disorder that causes kidney failure
• Lupus and other diseases of the immune system
• Obstructions
  Other conditions, such as congenital defects of the kidneys, may result in the need
  for a kidney transplant.
  There may be other reasons for your healthcare provider to recommend a kidney
  transplant.

What are the risks for kidney transplant?
As with any surgery, complications can occur. Some complications may include:

• Bleeding
• Infection
• Blockage of the blood vessels to the new kidney
• Leakage of urine or blockage of urine in the ureter
• Lack of function of the new kidney at first
  The new kidney may be rejected. Rejection is a normal reaction of the body to a
  foreign object or tissue. When a new kidney is transplanted into a recipients body,
  the immune system reacts to what it thinks as a threat and attacks the new organ.
  For a transplanted organ to survive, medicines must be taken to trick the immune
  system into accepting the transplant and not attacking it as a foreign object.
  The medicines used to prevent or treat rejection have side effects. The exact side
  effects will depend on the specific medicines that are taken.

Not everyone is a candidate for kidney transplantation. You may not be eligible if you
have:

• Current or recurring infection that cannot be treated effectively
• Cancer that has spread from its original location to elsewhere in the body
• Severe heart or other health problems that make it unsafe to have surgery
• Serious conditions other than kidney disease that would not get better after
  transplantation

Failing to follow the treatment plan
There may be other risks depending on your specific medical condition. Be sure to
discuss any concerns with your transplant team before the procedure.
.
How do I prepare for a kidney transplant?
To get a kidney from an organ donor who has died (cadaver), you must be placed on
a waiting list of the United Network for Organ Sharing (UNOS). Extensive testing
must be done before you can be placed on the transplant list.
A transplant team carries out the evaluation process for a kidney. The team includes
a transplant surgeon, a transplant nephrologist (healthcare provider specializing in
the treatment of the kidneys), one or more transplant nurses, a social worker, and a
psychiatrist or psychologist. Other team members may include a dietitian, a chaplain,
and/or an anaesthesiologist.

The evaluation includes:

• Mental health evaluation. Psychological and social issues involved in
  organ transplantation, such as stress, financial issues, and support by family
  and/or significant others are assessed. These issues can greatly affect the
  outcome of a transplant. The same kind of evaluation is done for a living
  donor.
• Blood tests. Blood tests are done to help find a good donor match, to check
  your priority on the donor list, and to help the chances that the donor organ
  will not be rejected.
• Diagnostic tests. Diagnostic tests may be done to check your kidneys as
  well as your overall health status. These tests may include X-rays, ultrasound,
  kidney biopsy, and dental exams. Women may get a Pap test, gynecology
  evaluation, and a mammogram.
  The transplant team will weigh all the facts from interviews, your medical history,
  physical exam, and tests to determine your eligibility for kidney transplantation.
  Once you have been accepted as a transplant candidate, you will be placed on the
  UNOS list. When a donor organ becomes available, you will be notified and told to
  come to the hospital right away.
  If you are to get a kidney from a living family member (living-related transplant), the
  transplant may be done at a planned time. The donor must have a compatible blood
  type and be in good health. A mental health check will be done to be sure the donor
  is comfortable with the decision.

These steps will happen before the transplant:

• Your transplant team will explain the procedure to you and you can ask
  questions.
• You will be asked to sign a consent form that gives your permission to do the
  surgery. Read the form carefully and ask questions if something is not clear.
• If you have been on routine dialysis before the procedure, you will get dialysis
  before the procedure.
• For a planned living transplant, you should fast for 8 hours before the
  operation, generally after midnight. In the case of a cadaver organ transplant,
  you should start to fast once you are told a kidney has become available.
• You may get a sedative before the procedure to help you relax.

Based on your medical condition, your transplant team may ask for other
specific preparation.

What happens during a kidney transplant?
A kidney transplant requires a stay in a hospital. Procedures may vary depending on
your condition and your healthcare providers practices.
Generally, a kidney transplant follows this process:
1. You will remove your clothing and put on a hospital gown.
2. An intravenous (IV) line will be started in your arm or hand. More catheters
may be put in your neck and wrist to monitor the status of your heart and
blood pressure, and to take blood samples. Other sites for catheters include
under the collarbone area and the groin blood vessels.
3. If there is too much hair at the surgical site, it may be shaved off.
4. A urinary catheter will be inserted into your bladder.
5. You will be positioned on the operating table, lying on your back.
6. Kidney transplant surgery will be done while you are asleep under general
anesthesia. A tube will be inserted through your mouth into your lungs. The
tube will be attached to a ventilator that will breathe for you during the
procedure.
7. The anesthesiologist will closely watch your heart rate, blood pressure,
breathing, and blood oxygen level during the surgery.
8. The skin over the surgical site will be cleansed with an antiseptic solution.
9. The healthcare provider will make a long incision into the lower abdomen on
one side. The healthcare provider will visually inspect the donor kidney before
implanting it.
10. The donor kidney will be placed into the belly. A left donor kidney will be
implanted on your right side; a right donor kidney will be implanted on your left
side. This allows the ureter to be accessed easily for connection to your
bladder.
11. The renal artery and vein of the donor kidney will be sewn to the external iliac
artery and vein.
12. After the artery and vein are attached, the blood flow through these vessels
will be checked for bleeding at the suture lines.
13. The donor ureter (the tube that drains urine from the kidney) will be connected
to your bladder.

14. The incision will be closed with stitches or surgical staples.
15. A drain may be placed in the incision site to reduce swelling.
16. A sterile bandage or dressing will be applied.
Talk with your healthcare provider about what you will go through during your kidney
transplant.

What happens after a kidney transplant?
In the hospital

• After the surgery, you will be taken to the recovery room. Once your blood
  pressure, pulse, and breathing are stable and you are alert, you may be taken
  to the intensive care unit (ICU) for close monitoring. In time, you will be moved
  out of the ICU to a regular nursing unit as you recover and you are closer to
  going home. Kidney transplant usually calls for several days in the hospital.
• A kidney from a living donor may start to make urine right away. Urine
  production in a cadaver kidney may take longer. You may need to continue
  dialysis until urine output is normal.
• You will have a catheter in your bladder to drain your urine. The amount of
  urine will be measured to check how the new kidney is working.
• You will get IV fluids until you are able to eat and drink enough on your own.
• Your team will closely watch how your antirejection medicines are working to
  make sure you are getting the best dose and the best combination of
  medicines.
• Blood samples will be taken often to check the status of the new kidney, as
  well as other body functions, such as the liver, lungs, and blood system.
• You will slowly move from liquids to more solid foods as tolerated. Your fluids
  may be limited until the new kidney is working fully.
• Usually, by the day after the procedure you may start moving around. You
  should get out of bed and move around several times a day.
• Take a pain reliever for soreness as advised by your healthcare provider.
  Avoid aspirin or certain other pain medicines that may increase the chance of
  bleeding. Be sure to take only recommended medicines.
• Nurses, pharmacists, dietitians, physical therapists, and other members of the
  transplant team will teach you how to take care of yourself once you are
  discharged from the hospital including care for your incisions.
• You will be ready to go home when your vital signs are stable, the new kidney
  is working, and you do not need the constant hospital care.

At home

• Once you are home, it is important to keep the surgical area clean and dry.
  Your healthcare provider will give you specific bathing instructions. Generally,
  the incision should not be submerged in water until the skin heals as this
  increases the risk for infection. The stitches or surgical staples will be
  removed during a follow-up office visit
• You should not drive until your healthcare provider tells you it’s OK. Plan to
  have someone drive you home from the hospital and to your follow-up
  appointments.
• Avoid any activity or position that causes pressure to be placed on the new
  kidney. Other activity restrictions may apply.
• Check your blood pressure and weight at home every day. Increases in these
  may mean your kidneys are not filtering fluid properly. You need to be seen by
  your transplant team promptly.

Tell your healthcare provider if you have:

• Fever, which may be a sign of rejection or infection
• Redness, swelling, or bleeding or other drainage from the incision site
• Increase in pain around the incision site, which may be a sign of rejection or
  infection
  Fever and tenderness over the kidney are some of the most common symptoms of
  rejection. A rise in your blood creatinine level (blood test to measure kidney function)
  and/or blood pressure may also suggest rejection. The symptoms of rejection may
  look like other medical conditions or problems. Talk with your transplant team with
  any concerns you have. Frequent visits to and contact with the transplant team are
  vital.
  Avoid places in which you may be exposed to anyone who may be sick. This is
  because your immune system will be suppressed to protect you from rejecting the
  new kidney. This will be a lifelong precaution.
  Your healthcare team may give you other instructions after the procedure, depending
  on your situation.
  What is done to prevent rejection
  To allow the transplanted kidney to survive in your body, you will be given medicines
  for the rest of your life to fight rejection. Each person may react differently to
  medicines.
  New antirejection medicines are continually being developed and approved. Your
  healthcare team will tailor medicine regimes to meet your needs.
  Usually several antirejection medicines are given at first. The doses of these
  medicines may change often, depending on your response. Because antirejection
  medicines affect the immune system you will be at higher risk for infections. A
  balance must be maintained between preventing rejection and making you very
  susceptible to infection.
  Some of the infections you will be especially at risk for include oral yeast infection
  (thrush), herpes , and respiratory viruses. Avoid contact with crowds and anyone
  who has an infection for the first few months after your surgery.

Liver Transplant
What is a liver transplant?
A liver transplant is surgery to replace a diseased liver with a healthy liver from
another person. A whole liver may be transplanted, or just part of one.
In most cases the healthy liver will come from an organ donor who has just died.
Sometimes a healthy living person will donate part of their liver. A living donor may
be a family member. Or it may be someone who is not related to you but whose
blood type is a good match.
People who donate part of their liver can have healthy lives with the liver that is left.
The liver is the only organ in the body that can replace lost or injured tissue
(regenerate). The donor’s liver will soon grow back to normal size after surgery. The
part that you receive as a new liver will also grow to normal size in a few weeks.

Why might I need a liver transplant?
You can’t live without a working liver. If your liver stops working properly, you may
need a transplant. A liver transplant may be recommended if you have end-stage liver disease (chronic
liver failure). This is a serious, life-threatening liver disease. It can be caused by
several liver conditions. Cirrhosis is a common cause of end-stage liver disease. It is a chronic liver disease. It happens when healthy liver tissue is replaced with scar tissue. This stops the liver
from working properly.

Other diseases that may lead to end-stage liver disease include:

• Acute hepatic necrosis. This is when tissue in the liver dies. Possible
  reasons include acute infections and reactions to medicine, drugs, or toxins.
• Biliary atresia . A rare disease of the liver and bile ducts that occurs in
  newborns.
• Viral hepatitis . Hepatitis B or C are common causes.
• Metabolic diseases. Disorders that change the chemical activity in cells
  affected by the liver.
• Primary liver cancers. These are cancerous tumors that start in the liver.
• Autoimmune hepatitis . A redness or swelling (inflammation) of the liver. It
  happens when your body’s disease-fighting system (immune system) attacks
  your liver.

The transplant evaluation process
If your provider thinks you may be a good candidate for a liver transplant, he or she
will refer you to a transplant center for evaluation. Transplant centers are located in
certain hospitals throughout the U.S.
You will have a variety of tests done by the transplant center team. They will decide
whether to place your name on a national transplant waiting list. The transplant
center team will include:

• A transplant surgeon
• A transplant provider specializing in treating the liver (a hepatologist)
• Transplant nurses
• A social worker
• A psychiatrist or psychologist
• Other team members such as a dietitian, a chaplain, or an anesthesiologist
  The transplant evaluation process includes:
• Psychological and social evaluation . Many different issues are
  assessed. They include stress, financial concerns, and whether you will have
  support from family or friends after your surgery.
• Blood tests . These tests are done to help find a good donor match and
  assess your priority on the waiting list. They can also help improve the
  chances that your body won’t reject the donor liver.
• Diagnostic tests . Tests may be done to check your liver and your general
  health. These tests may include X-rays, ultrasounds, a liver biopsy, heart and
  lung tests, colonoscopy, and dental exams. Women may also have a Pap
  test, gynecology exam, and a mammogram.
  The transplant center team will review all of your information. Each transplant center
  has rules about who can have a liver transplant.

You may not be able to have a transplant if you:

• Have a current or chronic infection that can’t be treated
• Have metastatic cancer. This is cancer that has spread from its main location
  to 1 or more other parts of the body.
• Have severe heart problems or other health problems
• Have a serious condition besides liver disease that would not get better after
  a transplant
• Are not able to follow a treatment plan
• Drink too much alcohol

Getting on the waiting list

If you are accepted as a transplant candidate, your name will be placed on a national
transplant waiting list. People who most urgently need a new liver are put at the top
of the list. Many people have to wait a long time for a new liver.
You will be notified when an organ is available because a donor has died. You will
have to go to the hospital right away to get ready for surgery.
If a living person is donating a part of their liver to you, the surgery will be planned in
advance. You and your donor will have surgery at the same time. The donor must be
in good health and have a blood type that is a good match with yours. The donor will
also take a psychological test. This is to be sure he or she is comfortable with this
decision.

What are the risks of a liver transplant?
Some complications from liver surgery may include:

• Bleeding
• Infection
• Blocked blood vessels to the new liver
• Leakage of bile or blocked bile ducts
• The new liver not working for a short time right after surgery
  Your new liver may also be rejected by your body’s disease-fighting system (immune
  system). Rejection is the body’s normal reaction to a foreign object or tissue. When a
  new liver is transplanted into your body, your immune system thinks it is a threat and
  attacks it.
  To help the new liver survive in your body, you must take anti-rejection medicines
  (immunosuppressive medicines). These medicines weaken your immune system’s
  response. You must take these medicines for the rest of your life.
  Some liver diseases can come back after transplant.
  To help the transplant be more successful, you may be started on hepatitis B or C
  medicines ahead of time, if you have these diseases.

How do I get ready for a liver transplant?

• Your healthcare provider will explain the procedure to you. Ask him or her any
  questions you have about the surgery.
• You may be asked to sign a consent form that gives permission to do the
  surgery. Read the form carefully and ask questions if anything is not clear.
• For a planned living transplant, you should not eat for 8 hours before the
  surgery. This often means not having any food or drink after midnight. If your
  liver is from a donor who has just died, you should not eat or drink once you
  are told a liver is available.
• You may be given medicine to help you relax (a sedative) before the surgery.

Your healthcare provider may have other instructions for you based on your medical
condition.

What happens during a liver transplant?
Liver transplant surgery requires a hospital stay. Procedures may vary depending on
your condition and your provider’s practices.
Generally, a liver transplant follows this process:
1. You will be asked to remove your clothing and given a gown to wear.
2. An IV (intravenous) line will be started in your arm or hand. Other tubes
(catheters) will be put in your neck and wrist. Or they may be put under your
collarbone or in the area between your belly and your thigh (the groin).These
are used to check your heart and blood pressure, and to get blood samples.
3. You will be placed on your back on the operating table.
4. If there is too much hair at the surgical site, it may be clipped off.
5. A catheter will be put into your bladder to drain urine.
6. After you are sedated, the anesthesiologist will insert a tube into your lungs.
This is so that your breathing can be helped with a machine (a ventilator). The
anesthesiologist will keep checking your heart rate, blood pressure, breathing,
and blood oxygen level during the surgery.
7. The skin over the surgical site will be cleaned with a sterile (antiseptic)
solution.
8. The doctor will make a cut (incision) just under the ribs on both sides of your
belly. The incision will extend straight up for a short distance over the breast
bone.
9. The doctor will carefully separate the diseased liver from the nearby organs
and structures.
10. The attached arteries and veins will be clamped to stop blood flow into the
diseased liver.
11. Different surgery methods may be used to remove the diseased liver and
implant the donor liver. The method used will depend on your specific case.
12. The diseased liver will be removed after it has been cut off from the blood
vessels.
13. Your surgeon will check the donor liver before implanting it in your body.
14. The donor liver will be attached to your blood vessels. Blood flow to your new
liver will be started. The surgeon will check for any bleeding where you have
stitches.
15. The new liver will be attached to your bile ducts.
16. The incision will be closed with stitches or surgical staples.
17. A drain may be placed in the incision site to reduce swelling.
18. A sterile bandage or dressing will be applied.

What happens after a liver transplant?
In the hospital

After the surgery you may be taken to the recovery room for a few hours before
being taken to the intensive care unit (ICU). You will be closely watched in the ICU
for several days.
You will be hooked up to monitors. They will show your heartbeat, blood pressure,
other pressure readings, breathing rate, and your oxygen level. You will need to stay
in the hospital for 1 to 2 weeks or longer.
You will most likely have a tube in your throat. This is so you can breathe with the
help of a machine (a ventilator) until you can breathe on your own. You may need
the breathing tube for a few hours or a few days, depending on your situation.
You may have a thin plastic tube inserted through your nose into your stomach to
remove air that you swallow. The tube will be taken out when your bowels start
working normally again. You won’t be able to eat or drink until the tube is removed.
Blood samples will be taken often to check your new liver. They will also check that
your kidneys, lungs, and circulatory system are all working.
You may have IV drips to help your blood pressure and your heart, and to control
any problems with bleeding. As your condition gets better, these drips will be slowly
decreased and turned off. You may receive antibiotics. Once the breathing and stomach tubes have been removed and you are stable, you may start to drink liquids. You may slowly begin to eat solid foods as directed.
Your anti-rejection medicines will be closely watched to be sure you are getting the
right dose and the right mix of medicines.
When your provider feels you are ready, you will be moved from the ICU to a private
room. You will slowly be able to move about more as you get out of bed and walk
around for longer periods of time. You will slowly be able to eat more solid foods.
Your transplant team will teach you how to take care of yourself when you go home.
 

At home
Once you are home, you must keep the surgical area clean and dry. Your provider
will give you specific bathing instructions. Any stitches or surgical staples will be
removed at a follow-up office visit, if they were not removed before leaving the
hospital. You should not drive until your provider tells you to. You may have other limits on your activity.

Call your healthcare provider if you have any of the following:

• Fever. This may be a sign of rejection or infection.
• Redness, swelling, or bleeding or other drainage from the incision site
• More pain around the incision site. This may be a sign of infection or rejection.
• Vomiting or diarrhea
• Bleeding
• Jaundice (yellowing of the skin and eyes)
  Your healthcare provider may give you other instructions, depending on your
  situation.

What is done to prevent rejection?
You must take medicines for the rest of your life to help the transplanted liver survive
in your body. These medicines are called anti-rejection medicines
(immunosuppressive medicines). They weaken your immune system’s response.
Each person may react differently to medicines, and each transplant team has
preferences for different medicines.
New anti-rejection medicines are always being made and approved. Your providerwill create a medicine treatment plan that is right for you. In most cases you will takea few anti-rejection medicines at first. The doses may change often, depending onhow you respond to them.
Because anti-rejection medicines affect the immune system, people who have a
transplant are at a higher risk for infections. 

Some of the infections you will be at greater risk for include:

• Oral yeast infection (thrush)
• Herpes

Respiratory viruses
For the first few months after your surgery, you should avoid contact with crowds or
anyone who has an infection.

Each person may have different symptoms of rejection. Some common symptoms of
rejection include:

• Fever
• A yellowing of the skin and eyes (jaundice)
• Dark-colored urine
• Itching
• Swollen or sore belly
• Feeling very tired (fatigue)
• Being easily annoyed
• Headache
• Upset stomach

The symptoms of rejection may look like other health problems. Talk with your
transplant team about any concerns you have. It is important to see them and speak with them often.

Next steps
Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• The risks and benefits of the test or procedure
• When and where you are to have the test or procedure and who will do it
• When and how will you get the results
• How much will you have to pay for the test or procedure

Pancreas Transplant
Pancreas transplantation is a type of surgery in which you receive a healthy donor
pancreas.
A pancreas transplant is a choice for some people with type 1 diabetes. Type 1
diabetes is an autoimmune disease in which the pancreas stops producing the
hormone insulin. The usual treatment for type 1 diabetes involves daily injections of insulin. During a pancreas transplant, you’ll receive a healthy pancreas from a donor who
has died. If you have kidney failure from your diabetes, your surgeon may also do a kidney transplant at the same time. The kidney transplant may be done earlier or even after the pancreas transplant.
In a pancreas transplant, your own pancreas remains in your body. The surgeon
generally connects the new pancreas to your intestines so its digestive juices can
drain. After a successful transplant, you’ll no longer need to take insulin. Instead, the new pancreas will create insulin for you. You can eat a regular diet, too. You’ll have few or no episodes of low (or very high) blood sugar or insulin shock and your risk for kidney damage will go down.

Who is a candidate for the transplant?
Candidates for pancreas transplantation generally have type 1 diabetes, usually
along with kidney damage, nerve damage, eye problems, or another complication of the disease. Usually, healthcare providers consider a transplant for someone whose diabetes is out of control even with medical treatment. This is true especially when
low blood sugar (hypoglycemia) has been a long-lasting problem. Select people with type 2 diabetes have received pancreas transplants as well. A pancreas transplant also works best on people without heart or blood vessel disease. If you choose a pancreatic transplant, you may be asked to stop smoking or lose weight before the surgery.

What are the risks?
The procedure’s risks are infection and organ rejection. Rejection happens when the body’s immune system attacks the new organ as a “foreign” invader. To reduce the chances of rejection, the healthcare team tries to match the blood and tissue type of the organ donor to the person getting the transplant.
After the transplant, healthcare providers prescribe special medicines that suppress the immune system, such as azathioprine and cyclosporine, to help prevent rejection of the new pancreas. However, these medicines make it more likely for people with a transplanted organ to pick up infections like colds and the flu. Over time, the medicines may also increase the risk for certain cancers. Because of the higher risk for skin cancer, for example, it’s important to cover up and wear sunscreen. If you get a pancreas transplant, you must take special medicines as long as you have the transplanted organ in your body. You will also need tests over the years to be sure that your pancreas transplant is still functioning adequately. It’s also crucial to keep all your healthcare provider appointments.

Is there a waiting list?
Currently, more people are in need of a healthy pancreas than can be provided for with donors. The wait for a pancreas can be quite long—on average, about 3 years. Surgeons may plan to do a pancreas transplant at the same time as a kidney transplant, to help control blood glucose levels and reduce damage to the new kidney. The chance of rejection is less if the immune characteristics of the donated organ match more and are capable of existing with those of the patient who receives the transplant.

What is the outlook after a pancreas transplant?
The long-term outlook for people who receive a pancreas transplant is quite good.
People who receive simultaneous kidney-pancreas transplants also tend to have
less chance of rejection. A positive long-term result depends on a number of factors including control of blood glucose.