Small Things Matter for Organ Transplant Recipients

By Edward F. Hollinger, MD, PhD

An organ transplant can only happen if there is an organ donor. When we encourage community members to consider becoming organ donors, we usually begin by describing how recipients benefit from transplantation. Mostly, we talk about the “big” things: a patient with cirrhosis from hepatitis C or liver failure from a Tylenol overdose who doesn’t die, a patient with kidney failure from hypertension who no longer needs dialysis (and statistically will live longer as a result), or a patient with end-stage heart failure who gets to see her children grow up because of a heart transplant. However, we often forget about the smaller but no less dramatic ways that organ transplants affect recipients’ lives.

During my transplant fellowship, I cared for a man in his mid-50s who had been a brittle diabetic since his teens. His diabetes eventually caused kidney failure, and he had to start dialysis. He was listed for and soon received a simultaneous kidney and pancreas transplant. Because of his multiple medical problems, he had a difficult post-transplant course. He had several readmissions to the hospital, mostly because of nausea and vomiting from the damage that diabetes had caused to his stomach and bowel. We all felt that he was a bit depressed that he had not recovered as quickly as we had hoped (and he had expected).

During a follow-up appointment a few months after transplant, I asked the patient how he felt about his kidney and pancreas transplant. I really wanted to ask if he thought that it was worth all the difficulties that he had undergone in the past few months, but I was a little reluctant to phrase the question that directly. Most transplant recipients are very positive about their life after transplant, but when there are difficulties, it usually takes a while for the “short-term pain” to fade into satisfaction.

However, rather than reflecting on the problems that were just now beginning to resolve or his new-found freedom from dialysis, he instead related a story. He told how for the last more than 20 years he had walked the same route on his way to work. Every day, he passed a bakery window filled with delectable treats, and every day it reminded him of how his diabetes defined his life. He cried as he described how, the week prior, he had finally gone into the bakery and purchased a pastry. For him, that pastry was a concrete moment marking the beginning of his new life without diabetes.

I wish that his organ donor’s family could have heard his story. The “big things” are important, but sometimes it is the small moments that make the most difference.

Edward F. Hollinger, MD, PhD, is surgical director, living donor kidney transplant and pancreas transplant in the Section of Abdominal Transplantation at Rush University Medical Center.

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