While each person’s journey is unique, here is an overview of what you can expect to experience before, during, and after your transplant. One of the most important initial steps you can take is to empower yourself with information, so we have prepared this summary to help demystify your journey—specifically, to help you understand the role modern diagnostics play in supporting your care throughout the transplant process and your path toward an improved quality of life.
The tests that labs use to help understand the genetic and physiological realities between a donor and recipient are vital to the transplant process, and will hopefully seem less mysterious to you. Ultimately, what all transplant diagnostics have in common is that, at every phase of your journey, they help your transplant team better understand your immune system. They also help make sure that you are ready to receive the new organ as quickly as possible, and that, after surgery, it will function harmoniously with your body. Even with the challenges of surgery and medication, transplantation is far less restrictive than other treatment options and holds the promise of a dramatic increase in both the quality and length of your life. (Click to expand this card)
The journey begins when your doctor identifies the need for a transplant. Depending on the nature of your case—the type of transplant needed and the urgency of your medical condition—your doctor may advise you to make lifestyle changes to increase the likelihood of a successful transplant or of your eligibility for placement on the organ transplant waiting list.
Your doctor will then refer you to a transplant program for further evaluation, or you may choose a program based on your location, resources, insurance, or other circumstances.
To begin preparing for your potential transplant, your transplant program team will learn more about you and help you understand the decisions that will determine your individual transplant journey. There are two types of donor organs for which you may be eligible: organs from either a deceased or living donor. Heart, and most lung and liver, donations are from deceased donors. For kidney, stem cell, and other transplant types, you may seek a living donor. Both types have a high success rate, but the scheduling can be more predictable with living donors. According to the Organ Procurement and Transplantation Network, in 2020, 85% of organ donations were from deceased donors. And while most living donations are from family members, one out of four are from donors who are not biologically related to the recipient (American Transplant Foundation). You will confer with your transplant team to determine the right type of donor for you.
Each transplant hospital team has its own criteria for determining your eligibility for receiving a transplant or being placed on the national waiting list. If you are found to be a good transplant candidate through the screening process, your team may schedule your transplant if you have been matched with a living donor, or they may add you to the waiting list, where your wait time will vary depending on your needs and the availability of a compatible donor. Transplant hospitals in the United States enter information from donors and candidates into a database operated by the United Network for Organ Sharing (UNOS), which helps match candidates with donor organs.
As part of determining your transplant eligibility and needs, the pretransplant screening process involves three main types of clinical diagnostics (laboratory tests):
Immediately prior to surgery, an additional test, called a crossmatch test, is performed to verify that your donor organ is compatible. Think of it as a miniature test run on the transplanted organ, undertaken in the laboratory. Donor and recipient blood samples are mixed. If antibodies in the recipient's blood attack and kill the donor cells, the crossmatch is considered positive. This means the recipient has previously developed antibodies against the donor’s cells and the transplant cannot move forward. If the crossmatch is negative, the recipient does not have antibodies against the donor HLA and the transplant can be performed.
For heart and lung transplant patients, the crossmatch test is typically performed immediately after surgery, though there are exceptions where the transplant clinical team may choose to perform it beforehand.
Some transplant centers may perform a “virtual” crossmatch test, in which data on the patient’s HLA typing and antibody status are compared with the donor’s typing via analytical software, such as our HLA Fusion™ Software. This allows the transplant center to assess how a patient’s antibodies would interact with the donor cells in a regular crossmatch test. This virtual test is particularly helpful in cases when the transplant clinical team is trying to determine whether a donor organ from outside the regional area would be a good match for their patient.
The typical recovery time after transplant surgery can vary depending on the type of transplant. Kidney patients may require 3 to 4 weeks for recovery; heart and lung patients may take around 6 to 8 weeks. Regardless of the type of transplant, this is when you will begin your regimen of immunosuppression medication, which you’ll need to maintain for the life of your transplant. Transplant doctors emphasize the critical importance of complying with this medication regimen since there is a high rate of correlation between lack of adherence and transplant rejection. Simply put: after your transplant, taking your medicine becomes as vital a part of your life as breathing, eating, and sleeping.
Your journey doesn’t end with the transplant—even if you’ve received a donor organ from an excellent match, it’s not an exact duplicate of your organ. Therefore, an organ transplant is a lifelong treatment rather than a cure. Your life after transplant will include continued adherence to your medical regimen as well as regular monitoring for donor-specific antibodies (DSAs), usually every few months in the first year and less frequently in subsequent years, depending on your health, the circumstances of your transplant, and the protocols of your transplant center. You may require additional tests such as biopsies during the monitoring phase, and your immunosuppressive regimen may be adjusted based on the results.
In cases where your medical team may need a closer view of the state of your transplanted organ, a biopsy of the transplant organ may be required. By taking a biopsy sample, your transplant clinician can determine whether your organ is normal or may be experiencing rejection or injury. A test such as our Molecular Microscope® Diagnostic System for Heart and Kidney (MMDx® Heart and MMDx® Kidney) allows your clinical team to assess the health of the organ on a molecular level and make a more accurate diagnosis.
The tests that labs use to help understand the genetic and physiological realities between a donor and recipient are vital to the transplant process, and hopefully, they now seem less mysterious to you. Ultimately, what all transplant diagnostics have in common is that, at every phase of your journey, they help your transplant team better understand your immune system. They also help make sure that you are ready to receive the new organ as quickly as possible, and that, after surgery, it will function harmoniously with your body. Even with the challenges of surgery and medication, transplantation is far less restrictive than other treatment options and holds the promise of a dramatic increase in both the quality and length of your life.
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While each person’s journey is unique, here is an overview of what you can expect to experience before, during, and after your transplant.