The Most Important Transplant Surgeon Conversation- Providing an Outline of the Transplant Surgical Procedure

The  most important conversation that a transplant surgeon needs to have with any potential recipient relates to the planned transplant surgical procedure. This involves describing what the actual procedure involves, as well as any potential problems that can occur with the surgery followed then by the expected post-operative course.

All transplant surgical procedures are considered major operative procedures and there are common elements which they all share-

a)     Making an appropriate incision either on the chest or the abdomen to gain the required access

b)    The surgical removal of the recipients own diseased organ in the case of the lungs, liver and heart in order to make space for the new organ to be transplanted. This also requires that some blood vessels and other structures need to be preserved to assist with the next phase of the surgery.

c)    Implanting the new donor organ which involves suturing a number of vessels and other pipes/structures that are specific to each type of donor organ

d)    Ensuring that any other problems such as bleeding are then dealt with

e)    Inserting drainage tubes and closing the incision

 Once the surgery is completed one of two things then happens-

1)    In the case of kidney recipients, most of the time the patient can be woken up from the anaesthetic and transferred to a ward or step-down unit for close post-operative monitoring to occur

2)    For the heart, lung and liver recipients most patients are kept asleep at the end of the surgery and transferred straight from the operating room to the intensive care unit for ongoing close monitoring. This is required until it is apparent that the patient is stabilising following the surgery and that the newly transplanted organ is functioning.

The nature of the surgery and the expected post-operative course can generate many other questions. There are some general guides available including via the Internet. In particular via the MedlinePus site in the United States-  Liver transplantation heart transplantation kidney transplantation  lung transplantation

The pieces of information that need to be put together for every transplant recipient including the last piece of information that can be obtained only during the actual transplant procedure.

However both the magnitude of the surgery as well as the range of possible complications do vary depending on both the organ being transplanted and how unwell each potential recipient is at the time of the transplant procedure -

       a) How each transplant recipient fares during the surgery and early on post operatively is   
           related to the many specific bits of information that need to be put together at the time-as 
           outlined in the above image.  


      b)  It is important to remember that the last 2 pieces of the recipient information jigsaw 
           puzzle are only able to be put together in the operating room during the actual transplant   
           surgery. For example there is no test for how much scarring may be present in the 
           abdomen in a liver recipient who has undergone previous surgery, hence this can only be 
           determined during the actual transplant surgical procedure. 


      c) Also if the combination of all of the non-surgical pieces of information were to predict an 
          unfavourable outcome in advance for a recipient, then the transplant surgery would not be 
          able to go ahead.

Hence specific advice should be sought by potential transplant patients and their relatives from the transplant programme that they are currently in contact with. There are both pluses and minuses from currently seeking health care advice only via the Internet as outlined via the following link- Mashable- what-doctors-think-about-your-online-health-searches


Image designed by Deb Verran 2012: acknowledgement Presentation magazine

Another Transplant Surgeon conversation: Waiting for an organ transplant

When a transplant surgeon is holding a conversation with a patient who requires an organ transplant, there is one topic that usually attracts more questions. It is the timing of that all important phone call that will be made to the patient with the offer of the donor organ. Can you imagine what it must be like to be listed for a transplant and waiting for that call day after day, week after week?

The conversation often goes like this-
Q: So doctor, when will I get the phone call [about the donor organ being available]?
A: You can get the call any time of the day or night, week day or weekend. So even in the middle of the night it is important to answer the phone.
Q: Why is that?
A: Well, first because the deceased organ donors can be identified at any time in the hospitals. Second, there is a need to track down all of the potential recipients of the organs from each donor, as there are time limits once the organ donation process is underway.
Q: So when I receive the call, do I need to hurry to hospital?
A: Yes, you do need to make your way to hospital reasonably quickly, but also safely. This is so you can be prepared for the surgery. If you live a long distance from hospital, special arrangements may need to be made to get you there in time.
Q: After I get to hospital, when do I know the transplant is definitely going ahead?
A: Once the organ you require has been surgically retrieved from the donor and is cleared to be suitable for transplant, you will be told. The organ often also has to be transported to the hospital as well.

Explaining what is actually involved in the process for obtaining the organ from the organ donor through to commencing the actual transplant surgical procedure is important. The journey to a transplant can be tough on potential recipients and their loved ones. Some descriptions of this journey can be obtained via the Organtransplants web site.

It takes good co-ordination for the available organs from every deceased donor to be successfully transplanted. Time is often of the essence once the organs have been surgically removed from the donor, due to limits on storage times of the organs. In many countries this co-ordination is achieved by agencies and or networks of professionals. Further information on this part of the process can be obtained via professional sources including from the United States and the United Kingdom

Some other general web sites which provide information are-
Transplant Living , OrganTransplants Understanding , United Kingdom
If you or a loved one are waiting for an organ transplant, it is best to seek advice from the professionals in the Transplant Programme that you are in contact with.

What do Transplant Surgeons Do? We have conversations including about organ donation.

Transplanting organs into recipients is the job of 'Transplant Surgeons', doctors who are trained in the relevant field whether it be for the liver, kidney, pancreas, heart, lung or bowel. More info on transplant surgery can be sourced via the American Society of Transplant Surgeons

So, apart from performing this type of surgery what else do transplant surgeons do in a week?

Transplant surgeons are very much involved in helping assess potential transplant recipients. Once it is clear that someone is suitable to be 'listed' for a transplant then important conversations need to be held with that person and their significant family members. The surgeon communicates the reality of actually receiving the precious often life saving organ, which includes the chance of not receiving the organ in time, how long the actual wait may be and how organ allocation works in practice. During these conversations often there are many more questions that may be asked, all of which the surgeon will need to answer. This is not surprising as undergoing an organ transplant is no small thing for anyone[nor their family]. It is important to clear up any concerns or misunderstandings people may have!

So what are these kind of questions and how can they be answered? Here are some examples-

Q: Doctor, do you travel to the scene of car accidents/car wrecks to get the organs form people who have died?
A: No, because in order for organ donation to be able to occur, you have to have made it into hospital before you die of such major injuries, otherwise your organs will not be good enough to use for transplant.
Q: Members of my family are registered as organ donors, so that means that if any of them were to die then organ donation becomes an automatic process doesn't it?
A: It is important for people to register their intent in advance, however the family are still needed at the time to give the okay for the actual organ donation process to go ahead.
Q: But doesn't being registered as a donor save the family members from the emotional trauma of having to make  decisions at what is such a difficult time for them?
A: The family will not need to decide about  you being a donor if you are registered, but they are still needed to provide information to assist with the donation process. This includes the relevant family member(s), being asked about the donors past medical and social history which is important for checking on the donors back ground.

Finally the one topic where there often seems to be the greatest amount of confusion, anxiety, and misconceptions but for which gaining an understanding is important -

Q: I do not understand at all about 'brain death' what does it mean exactly?
A: 'Brain death' is declared when there is no longer any function of the brain to support you being awake, breathing on your own, plus being able to talk and to move. Also this has become an irreversible state due to there being major brain damage.

You can think about 'brain death' like this. Imagine your computer hard drive ceases to work despite the power being on and the computer from the outside appearing normal. Well, your computer ceases to function and so basically no hard drive, means no function. The same is for us, in that the brain can be seen to act like the hard drive, so no brain function means we cannot function. However unlike your computer where you may be able to replace the hard drive our brains are not replaceable at all. Also once our brain has sustained catastrophic damage it cannot be repaired either. This is why patients who are declared brain dead may 'appear' normal [like the outside of the computer] and the power supply is still on[the heart is still beating], however they can no longer function [which is why the breathing is supported by a ventilator].

So why is it important to understand about organ donation processes and also about 'brain death'? Because more understanding will translate into more people consenting to organ donation. Plus more organs can be transplanted on average from deceased donors post declaration of brain death versus for deceased donors where death has been declared following the heart having stopped beating.  

If you wish to know more, there is general information that can be found via web sites managed by reputable organisations. Here are some examples from Australia Health insite, the United States of America Organ donor gov and India Gift Your Organs Also, if you wish to provide feed back to this blog you are welcome to.

NB: If you or a loved one is undergoing assessment for an organ transplant or are actually on a transplant waiting list, and you are wanting more information then speak to your doctor or members of the team at the Transplant Centre concerned.