A young man was suffering from progressive jaundice, a bloated abdomen, fatigue and breathlessness. He had a heart defect from birth that had caused heart failure. This led to increased pressure on the veins connecting the heart and liver, which in turn led to liver failure. The failure of two vital organs was a challenge to treat and the only solution was a combined en-bloc transplant of the two organs.
Organ transplantation is one of the most challenging and constantly evolving super specialties. Multi organ transplants are the next level of achievement, representing a whole new level of surgical skill and interdisciplinary medical care. A multiple organ transplant is the surgical feat that involves transplantation of more than one organ system simultaneously.
Various organ combinations transplanted are:
- Heart and Double Lung
- Heart and Kidney
- Heart and Liver
- Liver and Kidney
- Pancreas and Kidney
- Multivisceral transplants like simultaneous Liver, Pancreas and Intestine
Who requires a multi organ transplant?
It is usually considered as a treatment option in case of long standing disease of one organ that inexorably results in the failure of the other organ systems. The heart and lung are intimately connected, physically and functionally. Therefore, failure of one will eventually lead to failure of the other. If only the primary organ affected is replaced, the patient may have no relief of symptoms and may not even survive.
Nowadays, with the help of a variety of devices such as Ventricular Assist Devices (short term or long term), Artificial lungs or combined artificial heart and lungs called ECMO, a lot can be done to stabilise these patients while they wait for a transplant. Multi organ transplants are technically more demanding, take longer time, patients are critical and the complication rate is higher.
Multi organ transplants are best undertaken in well established centres, which have:
- Experienced transplant departments (e.g. heart, lung, liver, kidney, pancreas, small bowel)
- State-of-the- art transplant facilities
- Proper coordination and planning of both donor and recipient operations, to a level of extreme precision and finesse.
- Cardiologists, Respiratory physicians, Critical care specialists, Infectious disease specialists, Endocrinologists, Nephrologists, Transplant surgeons and Vascular surgeons may all need to be involved.
- High level of expertise is required at the laboratory, critical care units, operating theatre and rehabilitation unit. In reputed institutions, new peéks are constantly scaled and each day witnesses fascinating and fantastic innovations.