New Delhi: Organ transplant can be called as one of the biggest achievements of modern medicines. It can save or greatly enhance the lives of patients whose organs have failed them. “When patients are referred for organ transplants, they usually are in such a state that they have very slim chances of survival,” said Dr. Vjay Vij, Director-Liver Transplant Department, Fortis Escorts hospital. In this situation, getting another chance to live a healthy and long life is not less than a miracle. However, bringing life back to normal can be arduous and requires some precautions and restrictions to be followed to increase the longevity of the transplant. Dr. Vijay Vij talks to NDTV about life post organ transplant.
Dr. Vij said,
After a transplant, we divide the process of recovery into two stages- the Intensive stage which is within the first six months of the operation and relax stage beyond the six months.
Further, the intensive stage has two parts- the first three months and the next three months. The first three months is the most crucial period for a patient. During this period a patient spends approximately one month in the hospital, one month within a very close proximity of the hospital and last one month the patient is allowed to go home. The patients and their families are counselled on the precautions that they need to take, once they go home.
There are some generic and some specific precautions that all patients need to take but the most important thing is that they have to avoid falling sick at any cost.
Here are some things that Dr.Vij advises the patients and their families in the process of recovery post-transplant:
The body of the patients will reject the new organ as it is a foreign tissue after all. The body’s immune system which protects the body from germs and harmful cells will realise that the organ is from outside and will fight it. To prevent this, the patients will be given medicines to weaken their immune system which are called anti-rejection medicines or immunosuppressants. Therefore, any patient who undergoes organ transplant needs to be on immunosuppressant medicines.
It is very important that patients take immunosuppressants exactly the way doctors have prescribed and never alter their drug schedule. But being on immunosuppressant makes patients more vulnerable to catching infections than others as it decreases the strength of the patient’s immune system.
Initially, there are three medicines, after three months there are two medicines and after one year there is only one medicine. Majority of the patients will be required to have single medicine per day for rest of their lives. However, for some, there can be variations according to their symptoms.
“The patients must avoid getting in touch with anyone who is having an infectious disease”, says Dr. Vij. He added,
Sometimes, patients may have an upset stomach, which is a common side-effect of immunosupperssants. Patients must always remain in touch with their transplant team and coordinators and let them know about every problem be it small or big. The doctor will change the medicines or alter the dose size if needed.
If the patient ever misses taking medicines, the doctor must be contacted right away. If the patient develops any new symptoms, they should always ask their transplant coordinator and the team about why it is happening.
The patients will be provided with a schedule for a regular check-up to check the blood levels and functioning of the organ transplanted and other organs. They have to stick to that schedule and never miss a check-up. In most cases, the patients are required to go for the check-up two times in a week during the first month after the transplant, once in a week after two months, every fortnight in the third month, and after three months, the check-up is required to be done once in a month.
The new organ may stop working overtime and so the patient may require another transplant after the first transplant. Dr. Vij said,
On an average, in case of heart, liver and kidney transplants, if the patients follow medicines and check-up routine and avoid falling sick, 90 per cent of the patients can survive on the new organ for almost ten years.
The patient may also face a relapse. Relapse is when the disease comes back which is common in the first year after the transplant and the risk lowers over time. When this happens, the doctor may suggest some treatment options including another transplant depending upon the intensity of the disease.
Maintaining hygiene is of utmost importance since the organ transplant patients are more susceptible to catching infections than others. They have to avoid vector-borne diseases like diseases caused by mosquitoes and other insects. They should not go in crowded places for the first six months after the transplant. Whenever they greet somebody with a handshake, they should use a hand sanitizer afterwards. They should wash their hands as frequently as possible.
The patients will be required to follow healthy dietary habits like they have to quit smoking and consuming alcoholic drinks, they should not put on weight and they should not eat from outside at any cost because any infection will be dangerous for their life. The patients can only have cleanly cooked food.
The patient will need to eat food low in salt and fat to prevent high blood pressure. If the patient has diabetes, it is important to watch the sugar level. Taking help of a dietitian can be a way to make sure that the patient follows a healthy diet which also works for their new organ.
Once the patient has recovered from the transplant surgery, they may be able to start an exercise routine. Exercise can help improve the overall health of the patient. However, it is important to discuss with the doctors about the exercises that patients can take up.
Dr. Vij said, “After one month of the transplant, we allow them to go for brisk walks and even jogging”. Lifting more than 5-10 kgs of weight is not allowed in the first year of time after the transplant as there are chances of a hernia developing. After one year, however, they can go to the gym and do their regular exercises.
Patients are advised to wait for a few weeks after the surgery and not put a strain on their bodies. Dr. VIj said,
Usually we allow patients to go back to work not sooner than three months and only if they feel comfortable enough
Getting an organ transplant is a life changing experience that a patient goes through. From losing all hope of being alive to waiting for an organ, to suddenly receiving a call about an available organ, and getting a transplant. It is normal to have all kinds of emotions during and after the process. This may lead to anxiety, depression and even guilt getting an organ from someone or being dependent on caregivers.
Dr. Vij said,
It is important for the patient to understand that they are not alone and many patients are experiencing the same.
As side-effects of heavy medications, the patients may have mood swings. The drastically changed post-transplant lifestyle may also make patients anxious.
Reaching out to family and friends for support can be very helpful. Dr. Vij said, “Keeping the transplant team of the patient informed about their emotional change is also very important as they can help the patient adjust to the medications and the new lifestyle.”
The doctors may not allow patients to take trips in the first two-three months after the transplant considering their vulnerability to catching infection much faster than others. While on vacation, it is important to have enough refills of immunosuppressants. Sunbathing is not allowed because that increases the risk of skin cancer post-transplantation.
Driving is not allowed for the first six months because there are certain medicines which need to be taken in high doses during the initial period after the transplant. This may affect the mind, cause tremors and vision changes. Once the medicines stabilise, then the patients can drive. However, Dr. Vij advises the patients to have someone ride with them when they resume driving.
Patients can resume a normal sex life once the area around the surgery is completely healed and they become comfortable. It is important to talk to the transplant team about birth control options that can work best with the medicines patients are taking post-transplant. Dr. Vij said,
There are many transplants that happen during reproductive age. We tell our patients not to have a pregnancy within one year of the transplant as it can be dangerous for both, the mother and the child.
The patient and their family have to keep a keen eye on symptoms that may not be right and must immediately contact their doctor and the transplant team. Taking medicines on time and exactly the way doctor had prescribed, avoiding infections and falling sick, keeping a healthy diet, not gaining weight, not putting strain on the body, and always reaching out to the family and friends for support are some of the key points to remember during the process of recovery and sustaining the transplant.
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NDTV – Fortis More To Give campaign aims to promote organ donation and encourage Indians to take the pledge to be an organ donor. India has among the lowest rates of organ donation in the world at 0.5 donor per million population, which is far less compared to over 30 donors per million in some western countries. On an average, five lakh Indians die every year unable to get an organ transplant in time due to the shortage of organs. Every year on National Organ Donation Day on November 27, a Walkathon is organised across different cities of India to raise awareness, bust myths about organ donation and encourage people to become organ donors. Over the years, the campaign has gathered support from celebrities like actor Irrfan Khan, Swara Bhasker, Gul Panag and Former Indian Hockey Captain Sandeep Singh.