Post-Organ Transplant FAQs

Yes, organ donor and recipient families can meet if they both agree. The transplant hospital and organ procurement organization manage the correspondence process to maintain confidentiality. Communication between donor and recipient families typically occurs via letters or cards, which are exchanged through the transplant center to maintain anonymity. If both families are interested in communicating and eventually decide to meet, the transplant center will facilitate a meeting. 

Transplant centers manage the correspondence and meeting process between families since they understand that the decision to interact and meet is often deeply personal. Some families find it comforting to communicate with the recipient of their loved one’s donation, whereas others may find it very overwhelming. Some families are comfortable expressing their gratitude in writing but are not comfortable meeting in person. Some families prefer not to communicate with each other at all. Transplant centers try to respect these differences and accommodate them as much as possible while working to maintain the privacy of donor and recipient families. Most transplant centers have their own requirements about family correspondence and meetings, but ultimately, they strive to ensure that all correspondence and interactions are achieved by mutual consent. 

Donor and recipient family meetings can be emotionally charged, often provoking complex emotions of gratitude and grief. These meetings can provide a sense of connection, reassurance, or a reminder that a loved one’s donation has made a positive difference in someone’s life. However, since these meetings can create an intense mix of emotions, many transplant centers offer counseling and support before and after the meeting. It is common for families to have an initial meeting with a transplant professional to prepare before meeting with another family and to have a debrief meeting to discuss the experience afterward. 

Ultimately, meetings between donor families and recipients are possible but need careful consideration. Although these interactions can provide emotional benefits, they require sensitivity to both families’ emotional readiness and privacy. Meeting is a significant personal decision based on the comfort level of the families involved and should be respected. Families considering meeting but uncertain if they are ready to take this step are highly encouraged to seek additional support and guidance from the professionals at their local transplant center.

Sources

“Connecting donor families & recipients.” United Network for Organ Sharing. https://unos.org/transplant/connecting-donors-and-recipients/ 

“Contacting my donor family.” United Network for Organ Sharing: UNOS Transplant Living. https://transplantliving.org/community/contacting-my-donor-family/ 

“National communication guidelines.” National Kidney Foundation. https://www.kidney.org/national-communication-guidelines 

The rejection rate for organs or tissues varies based on several factors, including:

• The type of organ or tissue transplant
• The overall effectiveness of post-transplant care
• The response from the recipient’s immune system

Three types of rejection can occur. These include: 

• Hyperacute rejection
• Acute rejection 
• Chronic rejection 

Hyperacute rejection occurs within minutes of the transplant and is the result of a complete mismatch of antigens. If the organ or tissue is not removed immediately, the patient will die. This rejection reaction is extremely rare due to the sophisticated technology available for matching organs today.

Acute rejection occurs within the first week to three months after a transplant. All transplant recipients experience acute rejection to some extent as their body’s immune system recognizes the presence of a foreign organ. This type of acute rejection is managed with a combination of immunosuppressive medicines such as steroids and cyclosporine A. These medicines have reduced rejection rates for organ transplant recipients by 10 to 15%. Rejection of transplanted tissue is very rare.  

Chronic rejection occurs over many years due to the recipient’s continued immune response to the transplanted organ or tissue. Over time, this can damage the transplanted organ, leading to decreased organ function or organ failure. There is no way to predict or prevent this type of long-term rejection, although prompt recognition of symptoms is important to maintain organ function as long as possible. 

The likelihood of rejection varies based on the organ or tissue transplanted and the degree of tissue match between the donor and recipient. For example, transplants from relatives have a lower risk of rejection, and rejection rarely occurs in transplants between identical twins. Cornea transplants are also seldom rejected since the cornea doesn’t receive any blood supply from the body, so there is a low chance of an immune reaction from the recipient. 

Sources

“Transplant Rejection.” MedlinePlus. https://medlineplus.gov/ency/article/000815.htm

“Preventing Organ and Tissue Rejection.” Donor Alliance. https://www.donoralliance.org/newsroom/donation-essentials/preventing-organ-and-tissue-rejection/ 

“Cyclosporine”. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK482450/#: 

Although successful recovery after organ transplant surgery depends upon many factors, medical advancements continue to improve outcomes in the United States. While statistics vary widely depending upon which organ was received, whether a donor is alive or deceased, age and general health of the recipient, and other factors, survival rates have steadily increased across the board. Kidneys are the most successful of all organ transplantations. Patient survival rates at one, three, five, and 10 years are 91.27%, 86.46%, 81.17%, and 78.15% respectively. 

Following surgery, organ recipients can expect to remain in the hospital for about 3-5 days following a kidney transplant and up to two weeks for other organs, such as a heart or lungs.  The transplant team will monitor recovery closely and provide needed supportive care. Like most surgeries, tenderness at the site of the incision is common in the first week. In most cases, patients are encouraged to start moving slowly soon after transplant surgery.

Immunosuppressive medications will be administered to lessen the chance of organ rejection. These drugs help to keep the immune system from attacking the new organ. Recipients will need to take some type of antirejection medication for the rest of their lives.

Although the benefits of receiving a new organ certainly outweigh the risks, there are a few risks associated with organ transplant surgery. These include:

• Complications related to use of anesthesia, including death
• Blood clots and bleeding
• Post-surgical site infection
• Infection: antibiotics are generally prescribed for up to 6 months to reduce risk
• Organ rejection or failure

What to expect after kidney transplant surgery

Beyond the recovery protocol and risk factors noted above for most organ transplants, kidney transplantation requires some additional care to ensure success. In most cases, the kidney makes urine right away. A catheter helps keep urine flowing properly while the patient heals. 

There are specific risks associated with kidney transplantation both before and after the hospital stay. These include:

• Acute Tubular Necrosis (ATN) or Delayed Graft Function – This means your kidney may be sleepy, or slow to wake up. Levels of creatinine remain too high because the kidney is not functioning well. Dialysis may be required for several weeks to months while the kidney recovers and creatinine levels drop. 
• Primary non-function – This means that the new kidney never starts working. In this case, a biopsy will be performed.. If irreparable damage is discovered, the kidney will need to be removed. A patient is put back on the waiting list; the original wait time is reinstated to increase the chance of a replacement kidney sooner than later.
• Dehydration – can cause creatinine levels to stagnate or drop, which threatens organ acceptance
• Urine Leak – During the transplant surgery, surgeons had to replace the ureter, the tube that travels from your new kidney to your bladder. This can separate from the bladder causing internal leakage. Surgery is the only treatment option to reconnect the ureter.

Recovery expectations at home for all organ recipients

After leaving the hospital, patients are required to follow a strict regimen to ensure their new organ continues to work properly. All physician orders must be followed regarding scheduled visits, lab tests, and medications. Although some daily physical activity may be advised, it is best to avoid heavy lifting, strenuous activities, or driving for the first few weeks. 

The transplant team will monitor the patient’s blood 1 to 2 times a week for creatinine levels and more. Patients are expected to closely monitor their health at home, as well. Changes in blood pressure, weight, temperature, or pulse may indicate complications and should be reported.

Organ rejection is the most constant threat to the patient’s health. Anti-rejection medications may need to be adjusted over time. Organ recipients must always guard against exposure to illness, as these medications weaken the immune system. Patients are also at a higher risk of infections, so any sign of fever, drainage from the surgical site, or an illness that does not resolve itself should be reported to the medical care team.

Other medications may be given in conjunction with immunosuppressants to ease a variety of potential side effects, which may include the following:

• Acne
• Headache
• Nausea or diarrhea
• Dry mouth
• Swollen or bleeding gums
• Mouth ulcers, tumors or thrush
• Hair growth or loss
• Bone thinning or damage
• Elevated blood sugars or Diabetes
• High blood pressure
• High cholesterol
• Weight gain 

If all goes according to plan, full recovery can be expected about 3 months following surgery. The probability of living a quality life after organ transplant surgery is increased by maintaining a healthy lifestyle, including a balanced diet and regular exercise.  

Sources

“Graft and Patient Survival Rates in Kidney Transplantation, and Their Associated Factors: A Systematic Review and Meta-Analysis”. Iranian Journal of Public Health. https://pmc.ncbi.nlm.nih.gov/articles/PMC8643514/ 

“Immunosuppressants (Anti-rejection Medicines)”. National Kidney Foundation. https://www.kidney.org/kidney-topics/immunosuppressants-anti-rejection-medicines 

“Acute tubular necrosis”. MedlinePlus. https://medlineplus.gov/ency/article/000512.htm 

“Creatinine”. National Kidney Foundation. https://www.kidney.org/kidney-topics/creatinine 

“Primary Nonfunction of Renal Allograft Secondary to Acute Oxalate Nephropathy”. Case Reports in Transplantation. https://onlinelibrary.wiley.com/doi/10.1155/2011/876906 

“Early urological complications after kidney transplantation: An overview”. World Journal of Transplantation. https://pmc.ncbi.nlm.nih.gov/articles/PMC6134271/