Mark Miller, C.Ss.R., Ph.D.
Most people that I have met would not hesitate to get a new heart or kidney or liver if they really needed one in order to live. However, when I begin to talk with them about what such a transplant might mean for their lives, I find that these same people assume that a new organ is a little like getting a new part for a car. There is, of course, the operation to worry about, but the attitude seems to be, “If I am suffering from a heart that is not working, then a new heart will solve the problem.”
Well, the new heart may solve some of the problems, but a transplant has its own difficulties many of which most people are unaware until they or a loved one faces a transplant situation. Similarly, I find that many people just assume that the doctor knows best and if a transplant is suggested then that is what is needed.
To begin with, because doctors know that transplants have plenty of risks with them, it is very rare in Canada that a doctor would recommend one unless the patient really had no other options. Sometimes a transplant specialist will perhaps lean a bit too quickly towards a transplant and not take all the time necessary to explain any other options (and their accompanying risks) that might be available. However, if you are suffering from the failure or impending failure of a major organ, what should you consider in making your decision?
First, it is your decision. No one can force an organ transplant on you. That may sound obvious, but a transplant is a major operation and some transplants bring along major risks. One needs to have all the information about transplants before making a decision.
The risks of transplantation depend to a great extent on the kind of transplant, although all surgery has its own risks in terms of outcomes. However, the risks for receiving a new lens for one’s eyes are considerably less than those for a heart transplant.
Briefly, the number one problem with any transplant is the possibility of rejection. Since the donated organ is a ‘foreign’ object to the body, the immune system naturally seeks to protect the integrity of the body by attacking this foreign object. Transplants only became possible when immunosuppressant drugs were discovered which could prevent, in most cases, the rejection of the new organ. Developments in these drugs as transplants become more common have greatly improved the chances of avoiding rejection. Nonetheless, a side effect of immunosuppressant drugs is a weakened immune system for other infections. Accordingly, the person with the new organ must be particularly careful about illnesses.
Most of the concerns dealing with the surgery and the immunosuppressant drugs are relatively easy to assess when a person is receiving a kidney or a liver. Those whose kidneys have failed at least have the option of renal dialysis, a procedure that substitutes for the function of the kidneys. (Dialysis has its own burdens, of course, including the time spent for the frequent treatments and the fact that dialysis cannot completely replace kidney function.) However, a kidney or liver transplant can free a person to continue a more-or- less ordinary pattern of life, except for the life-long need for immunosuppressant drugs.
More critical questions arise when more serious organ transplants are considered. A heart transplant is wonderful— when it works. For many people, other medical problems make a heart transplant an ordeal of drugs, further surgery and less- than-optimal physical strength. Heart-lung transplants represent a further stage in complications. Though relatively rare, they are being done in otherwise hopeless cases; but the results are not near as positive as with simple heart transplants. Recipients of heart and lungs often face a very difficult convalescence and a poor success rate.
In other words, is every transplant a worthwhile one? I repeat that most are literally a new lease on life. However, some patients have made it abundantly clear that if they had known what was in store for them, they never would have accepted the transplant. Such responses suggest to me that every transplant decision ought not to be automatically accepted. So how should a potential recipient respond to the offer of a new organ or organs? I would offer four considerations.
1.) If the doctor suggests a transplant, ask first what the alternatives are. Ask questions. The risks of surgery and subsequent drug therapy, depending upon your age and health, may make alternatives most critical to your decision.
2.) Learn everything you can from the doctor (and anywhere else) about the results of a transplant: What are the risks? What will it be like to live with the transplant (it is often helpful to talk with others who have been through this)? What are the pros and cons of the transplant? What are the success rates, overall and for this surgeon? Ask questions. It is your decision. Furthermore, it is important to remember that there are times when refusing a transplant is not a death-sentence or a suicide, but a responsible decision under the difficult circumstances of one’s life.
3.) If you opt for a transplant, go in with courage, confidence and hope. If you have doubts, talk them over with your physician (and make sure that there is a good level of trust present) and your loved ones and, perhaps, a spiritual advisor. However, when you go for it, do so with all your energy, for attitude is almost as important as the operation.
4.) And, finally, just to make you think a bit, do not be afraid to ask where the donated organ comes from. You will not be told the identity of the person, for anonymity often has great psychological benefits. I do, however, raise this issue because the trade in body parts has been rumoured to be serious, and even deadly, in places like Latin America, India and Russia. Unscrupulous persons have been able to make considerable money from human body parts and there are occasional rumours about people being killed for their organs. (Another ethical issue has arisen where North Americans have gone to India and literally purchased a kidney from a poor, usually young, person.) Doctors in North America are meticulously honest about the ethics of donations. Systems can sometimes, however, let in the unscrupulous. Asking questions may sound like ‘bad faith,’ but it keeps the players in the system honest if they have to make sure that their answers continually fit their own principles.