Multiorgan transplants

A multiorgan transplant is a complex procedure. Learning how it works can help you and your family feel more prepared. At Mayo Clinic Transplant Center, specialists have strong expertise in doing transplants that involve more than one organ. Our experts work as a team to carefully review each person's health needs and treatment options. By closely working together, our experts gain a full understanding of your condition. They design a complete, coordinated plan tailored to your specific needs. Care plans often include innovative and complex procedures available at only a select few institutions.

Depending on your needs, your transplant team may include:

Medical specialists

  • Surgeons who specialize in transplanting solid organs, such as heart, lung, kidney, liver and pancreas.
  • Doctors with specialized knowledge of each organ and its related systems.
  • Specialists in infectious diseases.
  • Doctors from other medical specialties as needed.
  • Psychiatrists and psychologists.

Other care team members

  • Nurse transplant coordinators.
  • Pharmacists.
  • Dietitians.
  • Physician assistants.
  • Nurse practitioners.
  • Social workers.
  • Financial coordinators.

Pediatric multiorgan transplant

Mayo Clinic in Minnesota has highly skilled pediatricians and other doctors trained to treat children who need a multiorgan transplant. Pediatric transplant surgeons use specialized techniques that lessen the number of surgeries a child needs.

Understanding multiorgan transplants

If more than one of your organs is failing, Mayo Clinic teams may evaluate you for a multiorgan transplant. The surgery most commonly replaces two organs at the same time with healthy ones, usually from the same donor. But multiorgan transplant can include up to three organs, such as in a heart-lung-liver transplant. The number and type of organs involved depend on each person's specific needs.

Multiorgan transplant combinations may include:

  • Heart-kidney.
  • Heart-liver.
  • Heart-lung.
  • Heart-lung-liver.
  • Kidney-pancreas.
  • Liver-kidney.
  • Liver-lung.
  • Lung-kidney.

Conditions treated by multiorgan transplants

Your transplant team may discuss with you whether a multiorgan transplant is an option for you. The team reviews your health and explains if one of these transplants may help treat your condition.

  • Heart-kidney transplant is one of the more common multiorgan procedures. It may be an option for people who have both heart failure and kidney failure. It may be an option for people who have cardiogenic renal failure. This is a condition where the heart doesn't pump enough blood, which can cause the kidneys to fail.
  • Heart-liver transplant may be an option for people with end-stage heart disease and advanced liver failure. Some conditions can damage both organs, such as:
    • Cardiac cirrhosis, which is a type of liver damage caused by an inherited heart disease.
    • Amyloidosis, which allows proteins to build up in the heart and liver and in other organs. If enough proteins build up, the organs can eventually fail.
    • Failing Fontan physiology, which can occur in people born with only one ventricle and have had a Fontan procedure. The operation can create higher pressure in the veins that lead to the liver, eventually damaging it.
  • Heart-lung transplant is rare. It's usually an option only for people with advanced lung and heart diseases that a single-organ transplant cannot treat.
  • Liver-kidney transplant can treat people with both an end-stage liver disease and a kidney condition, such as organ failure or a chronic disease that requires dialysis. Some conditions damage both the liver and kidneys, including:
    • Metabolic diseases, which affect how the body breaks down specific substances and can allow these substances to build up in organs and cause damage. Examples include primary hyperoxaluria and methylmalonic acidemia.
    • Polycystic kidney disease, in which clusters of fluid-filled sacs, known as cysts, grow in both the kidneys and the liver and affect how they work.
    • Hepatorenal syndrome, which is a type of kidney failure that happens in people with liver conditions. Examples include advanced cirrhosis or sudden liver failure.
    • Wolcott-Rallison syndrome, which is a rare genetic condition that affects a certain protein, called PERK. This condition can cause diabetes in babies and young children and damage the liver over time.
  • Kidney-pancreas transplant is often done for people with diabetes who have kidney failure or are at high risk of it. The combined transplant can help prevent future kidney damage related to diabetes. Some conditions that may create a need for a kidney-pancreas transplant include:
  • Heart-lung-liver transplant is very rare but may be an option for people if all three organs are failing and other treatments have not worked.
  • Liver-lung transplant can help people with failing lungs and liver damage that can't be cured. Some conditions can damage both organs, such as:
    • Alpha-1-antitrypsin deficiency. This condition causes the body to make too little of a specific protein or to make a version that doesn't work as it should. As a result, the protein can't properly protect the lungs and may build up in the liver and cause damage.
    • Cystic fibrosis. This genetic condition mainly affects the lungs. When severe, it can damage the liver.
  • Lung-kidney transplant may be an option for people who develop severe renal dysfunction caused by immunosuppressive medicines after a lung transplant.

How does the waitlist work for multiorgan transplants?

If you need a multiorgan transplant, your Mayo Clinic transplant team assigns you an urgency status. This status shows how quickly you need a transplant based on your medical condition. Your status can go up or down if your health changes or your treatment plan changes.

To get the organs you need, your name goes on a national waitlist managed by the Organ Procurement & Transplantation Network (OPTN). OPTN makes sure that donated organs go to the people who need them most.

Healthcare professionals first consider people with the highest urgency, called Status 1. They then consider people with lower urgency who also match the donor. Factors in making an organ match include:

  • Blood type. To prevent illness in the recipient after transplant, it's important that the recipient and donor have blood types that are compatible.
  • The size of the organ compared with your body size. The donor organ needs to be the right size to fit well and work properly. For example, a heart that is too small may not pump enough blood, while an organ that is too large may cause pressure issues.

  • How sick you are. For some organs, such as the liver, healthcare professionals use a scoring system. A higher score means you are sicker and need a transplant more urgently, so you move higher on the list. For lung transplants, a Lung Allocation Score (LAS) helps decide priority. For kidneys, the length of time you've been on the waitlist is a main factor.

    If two or more people have the same urgency status, the system gives priority to the person who has waited the longest.

  • How far away the donor is. Because donated organs stay healthy outside the body for only a short time, distance matters. A shorter distance between the donor hospital and the transplant hospital means less travel time for the organs. Less travel time raises the chances of a successful transplant. People listed at hospitals closer to the donor hospital have higher priority than people with like status listed farther away.

    Sometimes no one matches at hospitals near the donor. In other situations, nearby hospitals receive the offer but choose not to accept it. When that happens, the OPTN system offers the organs to people at hospitals farther away.

Wait times can vary greatly based on the availability of organs and each recipient's needs.

How do you join waitlists for multiple organ transplants?

Your Mayo Clinic transplant team does a thorough evaluation to determine if a multiorgan transplant is safe and a good option for you. The evaluation process can take several days and may include:

  • A full physical exam.
  • Tests such as an X-ray, an MRI and a CT scan.
  • Blood tests.
  • Cancer screenings.
  • Surgical evaluation.
  • Psychological evaluation.
  • A review of your social and financial support.
  • Other tests based on your health history.

If you are well enough, you don't have to stay in the hospital for the evaluation. After your tests and appointments, your transplant team reviews the results with you. Then the team meets later to decide whether a multiorgan transplant is a good option for you.

To prepare you for a multiorgan transplant, your transplant team works with you to address any health issues and support your wellness. For example, if you have an ongoing infection, Mayo Clinic can coordinate treatment so you can get a transplant. Your transplant team also can connect you with experts to help you quit tobacco or treat drug or alcohol misuse that can affect your eligibility.

If the transplant team decides transplant is an option for you, the team adds your name to the national waitlist. You agree that you can get to the hospital quickly when an organ becomes available.

Mental and emotional health

Before a transplant, members of your care team talk with you about your mental and emotional health. They ask questions about your coping skills and your stress level. They ask about your family and your other support systems. They also talk with you about what you expect from the transplant and how willing you are to follow your care plan.

You are more likely to manage the challenges that come with a multiorgan transplant if you have realistic expectations. Strong coping and communication skills also help. Friends and family can help support you. Being able to follow your care plan can help you handle challenges too.

Caregiver support

Committed caregivers play a big part in a successful transplant. After a transplant, you need caregiver support to help you during your recovery. Your caregiver support can come from an individual, such as a partner, parent, sibling or friend. Or it can be a team.

You need to decide who your caregivers are before your transplant. They need to be responsible adults and may need to go to a class to learn how to help care for you.

Your caregivers need to be in good physical and emotional health. They get you to and from appointments, pick up your medicines, and help you with daily routines.

After you leave the hospital, you and one of your caregivers need to stay close to the hospital for a few weeks to a few months, depending on your situation.

What is the average life expectancy for people who have had multiple organ transplants?

Multiorgan transplantation is major surgery. How long someone lives afterward depends on several factors, including:

  • Which organs were transplanted.
  • The person's overall health before surgery.
  • How well the person follows the medicine plan after transplantation.

Getting regular checkups, taking medicines exactly as prescribed and practicing healthy habits all play a big role in long-term success. Your transplant team guides you through the steps you need to take to help make your transplant a long-term success.

How long does a multiorgan transplant take?

Multiorgan transplant surgery generally takes longer than a single-organ transplant and varies by the combination of organs involved. For example, a heart and liver transplant can take about 12 hours, while some abdominal multiorgan transplants, sometimes called multivisceral transplants, can take longer.

How Mayo Clinic helps you prepare

Regular appointments. You have tests and evaluations at Mayo Clinic as you wait for your transplant.

Monitoring your health. You have regular contact with your transplant coordinator who monitors medicine changes, new procedures you've had, such as a blood transfusion, and other changes in your health status. Your primary healthcare professional can contact your transplant team with questions about your care.

Arranging travel. Your transplant coordinator connects you to resources to help plan your travel. This important step helps you arrive at the hospital quickly after you're contacted for your transplant. Your team can help you create a backup plan in case things change.

Finding a place to stay. If you are traveling from out of town, your transplant social worker can suggest resources on housing near Mayo Clinic that fit your budget and needs.

Deciding what to pack. If your team thinks your evaluation needs to be done in the hospital, you likely will be in the hospital 2 to 4 days. It may be shorter or longer depending on your needs. If you have your evaluation as an outpatient, it typically takes a whole week. Your transplant team can tell you what to bring, such as medical supplies, medicines and eyeglasses.

When you get the call

When organs become available, someone from your Mayo Clinic transplant team calls you. You need to tell the caller if you have recently been sick, had a fever, been in the hospital, had surgery or had any changes to your medicines.

The caller tells you when to arrive and where to go in the hospital. The caller also gives you clear directions about what you may eat and drink before you arrive and any other restrictions to follow.

At the hospital

After you're admitted to Mayo Clinic, your transplant team does a final evaluation to make sure you can have the transplant. If the evaluation shows the donor organs are not suitable for you or if you are not ready to have surgery, you may not be able to have the transplant. If that happens, your transplant team talks with you about what comes next.

Your care in the hospital

After your surgery, your transplant team typically has you get up and start moving as quickly as you're ready. This helps you recover faster and lowers the risk of medical complications.

To speed your recovery after surgery, members of your healthcare team help you breathe deeply and cough. Coughing helps keep your lungs clear and can lower the risk of pneumonia. Coughing does not affect the healing of your incision.

Several monitors and tubes are used during surgery. The monitors record your oxygen level and blood pressure. After surgery, you get fluids and medicines through several intravenous (IV) lines.

During surgery, you may have a tiny plastic tube, called a stent, placed in your ureter to keep it open. The stent is taken out after surgery. You have a tube called a catheter in your urethra to drain urine from your bladder. Usually, the catheter is left in for a few days to a few weeks so your bladder can heal.

Possible complications

Some complications that are possible with transplant surgery are the same as with any surgery: infection, bleeding and blood clots. Rare complications include heart attack, stroke and death. After transplant, other complications may include a delay before your new organs start to work, organ rejection and high blood pressure. If complications such as bleeding, urine leaking or blockage happen, you may need another surgery to fix them.

Visitors

Your family and other visitors should check with your care team about visits. Visiting hours depend on how you're doing. Before visitors enter your room, they must always wash their hands. They may need to put on a hospital gown over their clothing. Visitors should not visit if they're sick.

Managing pain

You may have some pain as you recover. This is a natural part of the healing process. Your transplant team helps you manage pain safely. The goal is to help you be more comfortable so you rest when needed and still do the activities that can help you heal. Your healthcare team continually monitors your pain level to make sure it is well controlled and does not get worse.

Good nutrition

A healthy diet supports healing and recovery. After the transplant, a transplant dietitian works with you to find healthy foods that you enjoy. The dietitian also talks with you about diet restrictions to follow.

Emotional concerns

It's common for people who have had a transplant to feel many emotions. You may not sleep well in the hospital. You may be irritated because you can't do what you want to right away. Your medicine may make you feel anxious or sick. It also can cause mood swings.

You may be in pain. You may be worried, frustrated or angry. You may feel guilty if you're not happy or excited after a transplant. These are reasonable responses to a big health change. It can take time to adjust. Your transplant team can help if you have concerns about your emotions.

Leaving the hospital

People who have a multiorgan transplant at Mayo Clinic usually stay in the hospital for 1 to 2 weeks. However, your hospital stay may be shorter or longer. The time depends on your situation.

Your transplant team decides when you can leave the hospital based on:

  • Whether your new organs are working the way they should.
  • How well your incision heals.
  • Whether you need changes to your medicines.
  • How active you are.
  • Whether you and your caregiver can provide the care you need.

Also, before leaving the hospital, your transplant team makes sure you understand:

  • Your medicines and their side effects.
  • How to care for your incision and any drains or IV lines you have.
  • Symptoms of rejection and infection.
  • When to call your transplant team.

After you leave the hospital, you make frequent visits to Mayo Clinic for continued care. You need to stay near the clinic for a few weeks to a few months, depending on your needs. Your transplant team can let you know how long you need to stay near the clinic.

While you are staying close to the hospital, you usually come back to the clinic for appointments several times a week.

Blood tests

After your transplant, you need regular blood tests. The tests are done to check for infection and to track how well your medicines are working. While you're staying close to the hospital after your transplant, you have blood tests often.

You need to have regular blood tests for the rest of your life. Your transplant team lets you know how often you need blood tests after you go home and where you can have them done.

Going home

Before you go home, your transplant team helps prepare you for life after transplant. They can give you travel guidance, such as safely flying or traveling long distances by car. They can give you activity guidelines and suggestions for medical identification tags.

Your follow-up care

After you go home, you come back to Mayo Clinic a few months after your transplant. Then you come back to Mayo Clinic once a year around the anniversary of your transplant.