What happens when organs are donated for transplant?

Mansoor Madanur (c) and the surgical retrieval team
Image caption Abdominal retrieval surgeon Mansoor Madanur removed Penny's kidneys and liver

There are more than 10,000 people in need of a transplant in Britain, and each day three people die because of the lack of donors. For the first time television cameras have followed the organ transplant process right from when the decision is made to donate, until the recipients are recovering.

Penny was brought into St George's hospital in London after suffering a brain haemorrhage.

"At first she thought it was just a headache, minutes later she was screaming in pain," explained her husband Cyril.

Ten days later Penny was declared brain stem dead, at 65.

Of the 1,500 people who die each day in the UK, Penny was one of only three that were donors.

Penny's husband Cyril said she had always made it clear to her family that she wanted to donate her organs.

"She always believed that organs are lent to you in a strange sort of way and that if they can be used after death they have to be, there was no maybe as far as she was concerned, they had to be."

As this point, 40% of families usually decide not to donate, so specialist organ donation nurse Carol Wylie approached Cyril and his daughter Emma to make sure they would give the go-ahead.

Calls were then made using a nationwide database, and across the country people identified as potential recipients were called to hospital.

Daryl and her husband Alex travelled 200 miles from Devon to King's College Hospital in London. Alex is 52 and has been ill on and off for 20 years, with polycystic kidney disease.

Image caption Penny's daughter Emma and husband Cyril had spoken with her about her wishes to donate organs

"Although you prepare yourself for it, it's still a hell of a shock when that call comes, and you go through such a huge range of emotions," explained Daryl.

Alex had a failed kidney transplant last year, and needed a combined liver and kidney transplant.

"I feel totally tied up in knots in the inside," explained Daryl.

"I've got guilt because at the end of the day someone has died to make this possible and I've got fear that things won't work and that potentially I could lose him."

Quick decisions

Penny's heart was kept beating until her organs could be removed, but time was of the essence to remove them before they deteriorated.

Two surgeons were involved, a cardio thoracic specialist and an abdominal retrieval surgeon.

The specialist transplant team included Ruby Masden, a perfusionist, who looks after the preservation of the organs.

"It looks like any ordinary surgery, we try very much to respect the donor as much as possible," said Ruby.

"Treat the body with respect, but then... it is the beginning of so many other lives from this one life."

When organs are removed they are checked for signs of previously undetected disease or damage.

Penny's organs were found to be in good shape, and as the organs were delivered to three hospitals across the country via courier, ambulance and helicopter, Carol turned her attention back to Penny.

She performed last offices, where the body is cleaned and the hair is washed before being returned to the family.

"It's lovely and peaceful now and this is how it should be at this time. There is no mad rush you can take your time and do a good job."

Alex was the first recipient of Penny's donated organs. As he headed into the high risk operation there were tears, as it was the fourth time his wife had said goodbye to him before surgery.

Andreas Prachalias, the lead surgeon operating on Alex, said during every transplant operation there was a "key point".

"This is the most crucial moment, we're going to reperfuse the liver, that's the point that people may die sometimes," he said.

"This phase is called reperfusion where blood flows again through the vein's and arteries. It's a heart-stopping moment."

Penny's second kidney was taken to Hammersmith hospital where 66-year-old Michael had to wait a further four hours for cross-match tests.

His damaged kidney was not removed but Penny's was put into him by surgeon Vassilios Papalois.

"There and then you change somebody's life for ever and it happens in front of your eyes and you are part of it," he said.

"I don't think there is any other surgical speciality that can offer you this joy, a lot of stress I can tell you, but a lot of joy as well."

Michael's operation went well and after a month in hospital he was able to go home "very grateful", after being tied to the hospital and a dialysis machine for seven years.

'Edge of life'

Penny's heart was flown to Birmingham Queen Elizabeth hospital for the youngest recipient, 16-year-old Zoe.

She had fluid on her heart, which had become enlarged and was rapidly deteriorating.

Professor Robert Bonser explained she was on the "edge of life." Her mother had even planned her funeral.

Image caption Zoe's mother Tracey admitted she had planned Zoe's funeral before a donor was found

But within 24 hours of Zoe being prioritised on the urgent transplant list her family were informed that a suitable heart had become available.

"Many hearts we go to inspect of older donors will have developed coronary heart disease, and it could have happened in Zoe's case that we would have said no it's not safe to proceed," explained Prof Bonser.

"If that had happened in Zoe's case she would not still be with us."

While all the operations involving Penny's organs went well, some recipients can reject organs. Patients have to take drugs for the rest of their lives and 15% suffer some rejection in the first year.

Alex's last transplant failed because his body could not cope with the anti-rejection drugs. But this time his body coped well.

Zoe felt well but six weeks after the operation she showed signs of rejecting the heart.

Her mother Tracey admitted they had not expected any problems.

"I did think it was going to be a cure and this has shocked me, it's really frightening."

After a week back in hospital and a stronger dose of drugs Zoe was allowed home.

At the end of the process Penny's family received a letter about where her organs had gone and how the recipient patients were getting on.

They broke down as they read the letter from Carol Wylie.

"They shouldn't be thanking us," said Cyril through tears.

Daughter Emma was incredulous.

"To imagine they get a call and their life has changed over night, it's incredible."

Transplant is on BBC One, Tuesday 4 October, 22:35 BST.

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