Organ transplantation is a complex process which involves various members of a team to work together efficiently to bring out the best outcome for the patient. Patient and family are the key members of this team because they are at the delivery end.

In this growing world, everyday organ transplants are changing thousands of lives. Transplantation isn’t just a surgery; it’s a long term partnership between the patient and treating team. From diagnosis to selecting the best treatment option to preparing patient and patient family for the challenges that lie ahead. There is often uncertainty, at times extended hospital stays and then an adjustment to life after the surgery is over—but always take your transplant team care and support, their continuous guidance every step of the way.

Evaluation

First step is evaluation- It is an opportunity for the transplant team to get to know the patient, and an opportunity for patient and family to ask questions and address concerns.

The evaluation also is a time for education. Tests and consultations will teach patient and family about the transplant process, and the results of the tests will determine if a transplant is the optimal path of care.

Visits with other members of the care team, such as the social worker, psychologist and nutritionist to evaluate patient’s emotional and physical readiness for the journey ahead.

After the evaluation, the entire transplant team meets to decide if patient is a suitable candidate for a transplant. Multidisciplinary team ensures that every potential treatment option is reviewed and given thoughtful consideration. Generally, there are three possible recommendations:

1. The evaluation has identified that a transplant is not possible.

2. The evaluation has identified there are other treatments or medications available that should be considered prior to transplant.

3. The evaluation has identified that transplant is a treatment option.

In all of these situations, the transplant team works with patient and patient family to develop a coordinated care plan.

Waiting for an organ

Once patient and the transplant team decides transplant is the best option, patient is placed on the Government waiting list as a potential transplant recipient, which is responsible for allocation of organ.

Waiting is often the most difficult stage of the journey since patient don’t know just how long the wait will be, but transplant team offers their physical and emotional support. While patient waits, team works closely to monitor the patient and makes certain that patient remains a transplant candidate. It is important for patient to follow nutritionist, physiotherapist, transplant coordinator and doctor’s instructions to maintain a sense of normal and stay as active as possible to prepare for surgery—and recover after surgery.

A donor may become available anytime, day or night. When transplant team contacts patient to come to the hospital, timing is critical, so they need to arrive as quickly as possible. They often need to have patient ready to go into the operating room within hours of patient arrival.

The surgery: preparation and recovery

Once patient have been notified a donor organ has been found, things move very quickly. Surgeons, anesthesiologist and nursing staff will prepare patient for the procedure. It’s normal to be nervous, but patient can rest assured. Other member of the team makes sure patient family members are comfortable and informed about the progress of the transplant throughout the surgery.

Recovery and post-surgical care

Post procedure patient needs to be monitored; he or she will go to Transplant ICU. Team works on recovery of the patient and keeps family informed about the progress. As patient recovers time for ward shift is coming closer, team of transplant pharmacists, dietitians, nurses, and others will educate patient and patient family on all aspects of caring for patient after the operation. This will include information about post-transplant medications, activity, diet and any other specific instructions.

Following surgery, patient will need to take several medications daily. When a new organ is placed in your body, the immune system does not recognize its intended purpose. It sees the organ as something foreign and will try to fight it off. This is normal, however—in the case of a transplanted organ— to prevent the immune system from doing its job, patient will have to take immunosuppressants—also known as anti-rejection medications— to weaken the immune system, keep the organ safe and prevent the body from fighting off the new organ.

Medication schedule, proper administration of the medications, monitoring for side effects and monitoring for complications following the surgery, all are explained to patient and family. Transplant coordinator will work closely and will provide patient discharge education information, which will be developed specifically for the patient.

Entire transplant team is always available to answer questions, guide patient and family throughout hospitalization, and ensure that they are prepared to manage and maintain patient at home.

Life after Transplant

A transplant coordinator remains in constant touch with patient and family make sure everything is going well and will guide them at each and every step including – medications, investigations, diet, activity, follow up.

Follow-up appointments

Follow-up visits are essential to check patient’s medicine and—if needed—adjust the dosage, look for and treat any complications that might arise.

For the first month, team will want to see the patient frequently—typically twice a week. Over the first year, this decreases to once a week, then every other week, then once a month, then every 2 to 3 months. Generally, after a year it is preferred to see the patient every 3-6 months.

Rejection

Although it sounds scary, rejection is a normal reaction of the body’s immune system to a foreign object, and it may occur following a transplant.

Goal is to give patient adequate immunosuppressants to prevent rejection, while using the lowest dose possible to prevent side effects. Finding a good balance takes time and many medication adjustments may need to be made within the first few months.

It is during this period that rejection most often occurs. It can be identified by suspicious symptoms or routine check-ups. A number of tests are performed during the follow-up visits to help identify rejection, determine the effect on the transplanted organ and to formulate a treatment plan. .

Infection risk

Since the immune system will be less active, patient will be at a higher risk of infection. Anti-infection medications will be given to prevent or fight infections and other medications may be given to control side effects.

by

Shalini Suneel
Physician Assistant
KIMS Hospitals, Secunderabad.

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