0:00:02 > 0:00:08This programme contains some scenes which some viewers may find upsetting
0:00:08 > 0:00:12In Britain, over 10,000 people are in need of an organ transplant.
0:00:12 > 0:00:14Each day, three will die because of the lack of donors.
0:00:14 > 0:00:18It's Carol from the London team here, I'm offering you a heart from St George's.
0:00:18 > 0:00:23For the first time, this film shows the remarkable story
0:00:23 > 0:00:27of how a single organ donor can change the lives of many others.
0:00:27 > 0:00:30The heart's stopped.
0:00:30 > 0:00:33'You are aware that it's the end of a life, but then again'
0:00:33 > 0:00:39you realise that it's the beginning of so many other lives from this one life.
0:00:39 > 0:00:43With unprecedented access, we follow the incredible process
0:00:43 > 0:00:47from one person's death to multiple transplants.
0:00:47 > 0:00:51This is the most crucial moment, we are going to re-perfuse the liver.
0:00:51 > 0:00:55You have an organ which was in one person, you take it out,
0:00:55 > 0:00:58practically, for a few hours, it's dead.
0:00:58 > 0:01:03And then you transplant it, it comes back to life. It is a miracle happening in front of your eyes.
0:01:03 > 0:01:07Organ donation is based on strict anonymity.
0:01:07 > 0:01:11In this film, the donor's family and the organ recipients
0:01:11 > 0:01:16have agreed to waive their anonymity to allow us to tell their stories.
0:01:16 > 0:01:20One minute you've got an active and normal child,
0:01:20 > 0:01:24and the next minute she's needing a heart transplant, it's frightening.
0:01:24 > 0:01:31You do carry guilt because, at the end of the day, someone's died to give you that chance.
0:01:44 > 0:01:45Hold on, good girl!
0:01:45 > 0:01:48Yes! I did it!
0:01:50 > 0:01:53Ten days ago, following a brain haemorrhage,
0:01:53 > 0:01:5865-year-old Penny was admitted to St George's Hospital in London.
0:02:09 > 0:02:15Penny was sitting up on a bed upstairs and just saying, "I've got a headache."
0:02:15 > 0:02:16Then minutes later
0:02:16 > 0:02:19she was absolutely screaming in pain and asked for an ambulance.
0:02:19 > 0:02:21And that was a week and a half ago.
0:02:21 > 0:02:27Mum was in A&E and erm... She was...she was all right.
0:02:27 > 0:02:33She was on oxygen, but she could talk, and you know, we were joking about, you know,
0:02:33 > 0:02:39we made a few comments about a silver-haired doctor, as girls do.
0:02:42 > 0:02:47There was a point she wouldn't wake up, and she'd bled again.
0:02:47 > 0:02:53They take you into a room and there's a table with a box of tissues.
0:02:53 > 0:02:55At that point, you know it's really bad.
0:02:55 > 0:02:59They were just trying to bring her back, but they failed unfortunately.
0:02:59 > 0:03:01Not their fault, she just was too far gone.
0:03:02 > 0:03:07This morning at St George's, Penny was declared brainstem dead.
0:03:09 > 0:03:16Of the 1,500 people who die each day in the UK, Penny is one of just three who become organ donors.
0:03:16 > 0:03:19My name's Carol, I'm a specialist nurse for organ donation,
0:03:19 > 0:03:22could you page the cardiology registrar for me?
0:03:23 > 0:03:26Neuro ITU, yeah, bed seven.
0:03:27 > 0:03:32Penny had made it clear to her family that when she died she wished to donate her organs.
0:03:32 > 0:03:36After being approached by a specialist nurse, her family are supporting her wishes.
0:03:39 > 0:03:44It is a very sad job at the beginning of the process,
0:03:44 > 0:03:51but it's also a really rewarding job because, you know, I'm still saving lives.
0:03:51 > 0:03:56Not my donor's life, but I'm helping to save somebody else's life, somewhere else.
0:03:59 > 0:04:05I have consent for heart, liver, kidneys, pancreas.
0:04:05 > 0:04:10Working from a nationwide priority list, Carol alerts dedicated transplant centres
0:04:10 > 0:04:14that organs are available for transplantation.
0:04:14 > 0:04:19The donation process she is starting will eventually involve over 150 people.
0:04:19 > 0:04:23I'm offering you a heart from St George's.
0:04:23 > 0:04:2565-year-old female.
0:04:26 > 0:04:30Anybody could become an organ donor regardless of age,
0:04:30 > 0:04:33but for certain organs, there are strict criteria.
0:04:33 > 0:04:39For example, if you were to donate your heart you have to be 65 and under.
0:04:39 > 0:04:45If you were to donate your kidneys, you could be any age, into your 70s, sometimes into your 80s.
0:04:46 > 0:04:50Although Penny's on the upper age limit for heart donation,
0:04:50 > 0:04:53prior to her brain haemorrhage she was fit and healthy.
0:04:53 > 0:04:55She looks re...
0:04:55 > 0:04:58I'm telling you, she looks absolutely amazing.
0:04:58 > 0:05:02To look at her, you wouldn't think she was 65, she looks wonderful.
0:05:02 > 0:05:06While Carol finds suitable recipients for the organs,
0:05:06 > 0:05:11Penny continues to be looked after on the intensive care unit.
0:05:11 > 0:05:15Although she's been declared brainstem dead, her heart is being kept beating artificially
0:05:15 > 0:05:19to ensure that the organs are viable for transplantation.
0:05:19 > 0:05:24If your brainstem doesn't work, you'll lose the ability to breathe.
0:05:24 > 0:05:27If you lose the ability to breathe, your heart stops.
0:05:27 > 0:05:31Nowadays, with the technology, we can keep somebody breathing
0:05:31 > 0:05:37artificially, and keep the heart pumping artificially,
0:05:37 > 0:05:43not forever, but prolong this period beyond death.
0:05:43 > 0:05:47Penny's organs still need to be retrieved as soon as possible,
0:05:47 > 0:05:52as they will start to deteriorate the longer she is on the machine.
0:05:55 > 0:05:58Because organ donation is time-critical,
0:05:58 > 0:06:02across the country, specialist surgical teams are on-call 24 hours a day
0:06:02 > 0:06:05ready to perform organ-retrieval operations.
0:06:08 > 0:06:13Carol has mobilised two of these retrieval teams to come to St George's.
0:06:15 > 0:06:19The operation is performed by specialist transplant surgeons.
0:06:19 > 0:06:24They come from the transplant centres, they're the ones that do heart transplants
0:06:24 > 0:06:28or they do liver transplants and they're experts in this field.
0:06:28 > 0:06:30- Are you all right there? - Oh, yeah.
0:06:30 > 0:06:32- Do you want me to carry anything? - No, you're all right.
0:06:32 > 0:06:37The cardiothoracic team have come from Birmingham's Queen Elizabeth Hospital
0:06:37 > 0:06:40where a recipient is in desperate need of a new heart.
0:06:40 > 0:06:45The other surgical team have come just a few miles from King's College Hospital in southeast London.
0:06:45 > 0:06:48They will retrieve the liver and kidneys.
0:06:48 > 0:06:51- No pancreas.- No pancreas, no.
0:06:52 > 0:06:55Sorry, last little favour, one kidney we are taking...
0:06:55 > 0:06:59- You're taking one kidney, Hammersmith is having the other one. - Thank you.- OK?
0:06:59 > 0:07:03- I'll be with you as soon as possible to hand over.- No problem.
0:07:03 > 0:07:08With both surgical teams on site, they can now prepare to retrieve Penny's organs.
0:07:10 > 0:07:13She always believed that organs are lent to you
0:07:13 > 0:07:16in a strange sort of way.
0:07:17 > 0:07:22And that if they can be used after death she said they had to be.
0:07:22 > 0:07:26There was no maybe - as far as she was concerned they had to be.
0:07:26 > 0:07:32Like Penny, most people support organ donation in principle,
0:07:32 > 0:07:37but 40% of families still decide not to donate their loved ones' organs at the time of death.
0:07:37 > 0:07:41She always wanted me to be the one to make sure that it happens
0:07:41 > 0:07:45because she was always concerned that Dad wouldn't be strong enough
0:07:45 > 0:07:48to say yes at the time, and it turns out actually, at the time,
0:07:48 > 0:07:51he was, you know, he knew her wishes and he was very strong,
0:07:51 > 0:07:54but you don't know how people will be at the time when they're asked,
0:07:54 > 0:08:00and usually when you're asked it's the same time you're told your loved one is dying or has died.
0:08:08 > 0:08:11Across the country, the patients identified as suitable recipients
0:08:11 > 0:08:18for Penny's organs are called into hospital and prepared for the possibility of transplant surgery.
0:08:20 > 0:08:24One patient is called into King's College Hospital in southeast London.
0:08:24 > 0:08:29A specialist liver centre, it treats patients from across the country.
0:08:32 > 0:08:38Tonight, Alex and his wife Daryl have travelled over 200 miles to get to King's.
0:08:40 > 0:08:43I've only just grown it back!
0:08:43 > 0:08:4852-year-old Alex works in the motor trade. His life has been seriously restricted
0:08:48 > 0:08:51as he's been ill on-and-off for 20 years.
0:08:51 > 0:08:55He's already had one failed kidney transplant.
0:08:55 > 0:09:00Although you prepare yourself for it, you know it's going to happen, but it's still...
0:09:00 > 0:09:04It's still a hell of a shock when that call comes.
0:09:06 > 0:09:12And you go through such a huge range of emotion, it's incredible.
0:09:12 > 0:09:17This time, Alex desperately needs a combined liver and kidney transplant.
0:09:17 > 0:09:21Even though he's been blood-matched to Penny, it's too early to be sure
0:09:21 > 0:09:25her organs will be in good enough condition for transplantation.
0:09:25 > 0:09:29We're hoping theatre will be around eight o'clock in the morning, OK?
0:09:29 > 0:09:32The liver and the kidneys, they're being retrieved at the moment,
0:09:32 > 0:09:36so we're still waiting to hear from the surgeons,
0:09:36 > 0:09:43so it does mean we won't be able to tell you absolutely we'll go ahead until later on this morning.
0:09:43 > 0:09:46- Right.- OK?- Yep. That's OK.
0:09:46 > 0:09:51I'll be back down a bit later to let you know how things are, but...
0:09:51 > 0:09:56I feel totally tied up in knots on the inside.
0:09:56 > 0:09:58Erm... Excitement.
0:10:01 > 0:10:03Erm... Terror.
0:10:03 > 0:10:06'Because I've got hope,
0:10:06 > 0:10:10because hopefully this will help Alex.
0:10:10 > 0:10:17I've got guilt because, at the end of the day, someone has died to make this possible.
0:10:17 > 0:10:24I've got fear that things won't work, and that, potentially, I could lose him.
0:10:33 > 0:10:36It's 2:30 in the morning, and at the donor hospital
0:10:36 > 0:10:41the surgical teams are ready to begin the retrieval of Penny's organs.
0:10:45 > 0:10:51It's going to take a few hours now. It's not just quick in-you-go and grab everything and run again.
0:10:55 > 0:10:59The key thing is retrieving the organs safely without damages,
0:10:59 > 0:11:01I know that there's a patient
0:11:01 > 0:11:04waiting at the other end in my base hospital for a liver
0:11:04 > 0:11:06and he's not going to get the liver
0:11:06 > 0:11:09if I damage it, so that is always a pressure on me to do the job well.
0:11:12 > 0:11:16It looks like any ordinary surgery.
0:11:16 > 0:11:20We try very much to respect the donor as much as possible,
0:11:20 > 0:11:23you know, treat the body with respect.
0:11:23 > 0:11:27You are aware that it's the end of a life,
0:11:27 > 0:11:33but then if you realise that it's the beginning of so many other lives from this one life.
0:11:33 > 0:11:39Penny's heart will be kept artificially beating until they're ready to remove the organs.
0:11:39 > 0:11:43First, the surgeons need to check for any obvious signs of disease.
0:11:43 > 0:11:47My anxiety is, am I going to find any unexpected surprises?
0:11:47 > 0:11:51I have found previously healthy patients who have been donors
0:11:51 > 0:11:55and are opened up to find there are tumours or cancer.
0:11:55 > 0:11:59In every case I look for it, to see they don't exist.
0:12:01 > 0:12:06Once Mansoor, the abdominal surgeon, has made his initial assessment of the liver and kidneys,
0:12:06 > 0:12:11Abdul, the cardiothoracic surgeon, joins him at the operating table.
0:12:11 > 0:12:16Most of the time when you open people even younger than that donor
0:12:16 > 0:12:19you find coronary disease.
0:12:19 > 0:12:24I was expecting a thickened heart from high blood pressure,
0:12:24 > 0:12:31sometimes the heart may be not functioning well because of ageing.
0:12:31 > 0:12:36'I wasn't sure that heart would be useable.'
0:12:36 > 0:12:39Once both surgeons are happy there are no immediate problems
0:12:39 > 0:12:46they're ready to stop Penny's heart artificially beating and retrieve the organs.
0:12:46 > 0:12:50But this is a critical stage, as the organs will begin to deteriorate rapidly
0:12:50 > 0:12:55and the heart must be transplanted within four hours of leaving the body.
0:12:57 > 0:13:00To transport the organs as quickly as possible,
0:13:00 > 0:13:05specialist transport companies are on-call around the clock to drive or fly them anywhere in the country.
0:13:05 > 0:13:09You're hoping for the green light on the helicopter, just after five.
0:13:09 > 0:13:11- Blue light on the... Yeah. - Yeah, and...
0:13:11 > 0:13:15..and I've got to check that the driver's around as well. OK then.
0:13:15 > 0:13:20At this vital stage, emergency transport for the organs must be standing by.
0:13:20 > 0:13:24The retrieval will not proceed until everything is in place.
0:13:24 > 0:13:29- Right, hopefully we're getting the green light from the helicopter just after five.- Yes.
0:13:29 > 0:13:34As soon as we get that, then we can prepare to retrieve the heart.
0:13:34 > 0:13:38- OK, excellent.- As soon as we get that we're on the go.
0:13:39 > 0:13:42A few miles away, Alex is still waiting to hear
0:13:42 > 0:13:48if the organs will be viable for his combined liver and kidney transplant.
0:13:48 > 0:13:51I had a kidney transplant last year,
0:13:51 > 0:13:56but unfortunately it didn't work for me and I had some other problems
0:13:56 > 0:13:59and infections and I had to have that removed.
0:13:59 > 0:14:02Alex has polycystic kidney disease,
0:14:02 > 0:14:07which means his kidney is covered with cysts and no longer functions.
0:14:07 > 0:14:09He's been on dialysis for three years.
0:14:09 > 0:14:12The disease is now affecting his liver as well,
0:14:12 > 0:14:15causing it to swell to six times its normal size.
0:14:15 > 0:14:19My liver has grown to a certain extent that it's pressing on a main artery
0:14:19 > 0:14:23and it's not really the functioning of the liver.
0:14:23 > 0:14:26It's the shape and size of it that's causing me problems,
0:14:26 > 0:14:29and that's why I'm having a liver transplant as well.
0:14:33 > 0:14:37At the donor hospital, they wait to hear that the helicopter is ready
0:14:37 > 0:14:42so that they can begin the retrieval of the organs.
0:14:42 > 0:14:43PHONE RINGS
0:14:43 > 0:14:44Hi, Sharon.
0:14:46 > 0:14:51We can clamp, excellent, thank you very much. Bye.
0:14:51 > 0:14:56- Everybody ready?- Yes. - OK, new line is in.
0:14:56 > 0:15:00Finally they're given the go-ahead to stop the heart.
0:15:00 > 0:15:02The next few minutes are critical.
0:15:02 > 0:15:08Any problems in removing the organs could affect the future of the waiting recipients.
0:15:11 > 0:15:13The team stop the blood flow to the heart.
0:15:15 > 0:15:19Dead on 22 clamped, OK? 05.22.
0:15:20 > 0:15:21The heart's stopped.
0:15:33 > 0:15:38We perfuse the organs with cold fluid
0:15:38 > 0:15:44making the heart more cold, to protect it and preserve it longer.
0:15:44 > 0:15:48You have limited time to keep them alive, those organs.
0:15:49 > 0:15:53The ice-cold preservation fluid replaces the blood in the organs
0:15:53 > 0:15:58prolonging the amount of time they can be disconnected from a blood supply.
0:16:04 > 0:16:09At 5:40 in the morning, the first organ is removed - the heart.
0:16:10 > 0:16:14The surgeons won't know for certain the organs are viable for transplantation
0:16:14 > 0:16:18until they're thoroughly examined outside of the body.
0:16:25 > 0:16:30'The heart looks like a heart of a 20-year-old person,'
0:16:30 > 0:16:33I didn't believe, I felt this is the wrong patient we are doing!
0:16:33 > 0:16:36She had a good heart, that woman.
0:16:40 > 0:16:47'I informed the recipient centre immediately that the heart is a useable heart and is a good heart.'
0:16:51 > 0:16:56To keep the organs healthy en route to the transplant centres, they're chilled with ice.
0:17:03 > 0:17:08- Thank you very much.- OK. - Thank you so much.- Thank you very much, safe journey.
0:17:08 > 0:17:14The life of the patient in Birmingham depends on the safe and timely delivery of the heart.
0:17:17 > 0:17:25The specialist organ transport team are authorised to travel under emergency blue lights.
0:17:25 > 0:17:29We're just leaving St George's now with the heart on board
0:17:29 > 0:17:34and we're going to Regents Park for the rendezvous with the helicopter, thank you.
0:17:43 > 0:17:48It takes 15 minutes for the ambulance to reach Regents Park in central London,
0:17:48 > 0:17:53where the chartered helicopter has been given special clearance to land.
0:17:57 > 0:18:01The heart begins its final journey to Birmingham by air.
0:18:01 > 0:18:03- 'Thanks.'- Bye for now.
0:18:13 > 0:18:18The next organ to be retrieved is the liver, which has been allocated to Alex.
0:18:21 > 0:18:25Reasonable liver, non-fatty, it'll probably be about 1,100 grams,
0:18:25 > 0:18:30it's well perfused, no other injuries, no tear or anything else. OK.
0:18:32 > 0:18:38It's 6:15 and the news about the organs is relayed to the coordinator at King's,
0:18:38 > 0:18:41where Alex is waiting for a new liver and kidney.
0:18:41 > 0:18:45- Hi, Wendy.- 'Hi, Ruby, have you got some information?'- Yes.
0:18:45 > 0:18:50'It's a good liver, well perfused.'
0:18:50 > 0:18:54'No injuries, no damage.'
0:18:54 > 0:18:56OK, and the kidney's all right?
0:18:56 > 0:19:02- It is a little small, but they're OK. - He says that the kidneys are a little small but they're OK,
0:19:02 > 0:19:07- because the patient's not very big, they are...- Yeah, sure.
0:19:07 > 0:19:11- Is the anatomy normal on the kidney, the left kidney?- Yes.
0:19:11 > 0:19:13Anatomy is normal, no injuries.
0:19:13 > 0:19:18- Thanks, Ruby. Can you just let me know when you're leaving, please? - I'll let you know, yes.- OK, thanks.
0:19:18 > 0:19:22- Thanks, Wendy.- 'Thank you.' - Bye.- 'Bye.'
0:19:22 > 0:19:26Well, looks good, but the consultant makes the final decision.
0:19:26 > 0:19:30I'll just give him the information and then we can move ahead.
0:19:30 > 0:19:34We've got up to about 8-12 hours to transplant the liver,
0:19:34 > 0:19:39but obviously the sooner you transplant any organ, the better it will function.
0:19:43 > 0:19:49Across London, a patient in another hospital has been allocated Penny's other kidney.
0:19:49 > 0:19:54The Hammersmith Hospital treats people with acute kidney failure.
0:19:54 > 0:19:59One of their patients, 66-year-old Michael, is one of the potential matches for a transplant.
0:19:59 > 0:20:03He suffers from high blood pressure and diabetes.
0:20:03 > 0:20:07I use my walking stick because it helps me to get around...
0:20:08 > 0:20:13..you know, and when you get on a bus they're very kind,
0:20:13 > 0:20:16they always give you a seat, you know,
0:20:16 > 0:20:20because you've got a stick, you know, so I mustn't complain about that.
0:20:22 > 0:20:26Before he retired, Michael worked on the railways,
0:20:26 > 0:20:29but since his kidneys failed seven years ago,
0:20:29 > 0:20:33he's been having dialysis three times a week to keep him alive.
0:20:33 > 0:20:35He depends totally on dialysis.
0:20:35 > 0:20:39To put it simply, when you're on dialysis and you have renal failure
0:20:39 > 0:20:43you live in the hospitals and you go home every now and then.
0:20:43 > 0:20:50When you have a transplant, you live at home and have a good life, and go to the hospitals every now and then.
0:20:50 > 0:20:57'Every year on dialysis makes him more weak and frail actually, which increases the chances of dying.
0:20:57 > 0:21:01So it's not a very pleasant situation. Anything but that -
0:21:01 > 0:21:05a very difficult situation - so this kidney's a blessing for him.
0:21:05 > 0:21:09It's a very big day, and the thing most patients tell me when they get the phone call
0:21:09 > 0:21:13is that, first of all, they just can't believe it
0:21:13 > 0:21:14and they sort of shake,
0:21:14 > 0:21:18and sometimes, you know, they get very panicky and very nervous
0:21:18 > 0:21:21because sometimes they've been waiting for many, many years.
0:21:21 > 0:21:25Well, I've been on the list about four to five years.
0:21:25 > 0:21:27It is a long time.
0:21:28 > 0:21:31But, er...
0:21:31 > 0:21:38You can't rush these things because you've got to wait for someone to have a misfortune,
0:21:38 > 0:21:42you could say, for a kidney to come up, you know.
0:21:42 > 0:21:45- Right kidney?- Yes.- Right kidney.
0:21:45 > 0:21:47Thank you.
0:21:49 > 0:21:51Left kidney, thank you.
0:21:52 > 0:21:5520 hours since Penny was pronounced dead,
0:21:55 > 0:21:59the last of her donated organs are about to leave the donor hospital.
0:21:59 > 0:22:03The kidney allocated to Michael will be transported by a courier.
0:22:03 > 0:22:09- Kidney to go to the Hammersmith. - Yes.- That's correct, OK, they're expecting you.
0:22:09 > 0:22:15Out of all the donated organs, the kidneys can last the longest out of the body -
0:22:15 > 0:22:18up to 36 hours - before being transplanted.
0:22:18 > 0:22:21It's the first time I'm actually taking an organ,
0:22:21 > 0:22:24it's my third day on the job, so no pressure there.
0:22:27 > 0:22:31The other kidney and the liver will be travelling with the surgical retrieval team
0:22:31 > 0:22:35the few miles to King's, where Alex is waiting.
0:22:35 > 0:22:38They have a maximum of 12 hours to transplant the liver.
0:22:38 > 0:22:40- Wendy?- 'Yes?'
0:22:40 > 0:22:45We've just left the hospital, so a few minutes, I don't know, 20 minutes?
0:22:45 > 0:22:51- 20 minutes, I think. - That's fine. OK, thanks. OK, bye.
0:22:53 > 0:22:58- (I don't want to wake him up, but they are going to go ahead. OK?- Yep.
0:22:58 > 0:23:01- (Everything's fine, OK?) - What time's he need to get up?
0:23:01 > 0:23:06The anaesthetist will be around about eight, just after eight to take him to theatre.
0:23:21 > 0:23:24It's quarter past seven in the morning, and at the donor hospital
0:23:24 > 0:23:30the body has been closed and the organ-retrieval operation is over.
0:23:30 > 0:23:34Carol is performing last offices, where the body is cleaned and the hair is washed
0:23:34 > 0:23:40before being returned to the family for the funeral service.
0:23:40 > 0:23:44It's lovely and peaceful now, and this is how it should be at this time.
0:23:47 > 0:23:51I like it when it's like this, everything's over.
0:23:51 > 0:23:55And you can take your time, you know, there's no mad rush or anything,
0:23:55 > 0:23:59you know, you can just take your time and do a good job.
0:24:17 > 0:24:24The liver and kidney for Alex are about to arrive at King's College Hospital, ready for the transplant.
0:24:24 > 0:24:27The liver itself will take about five to six hours of plumbing it in,
0:24:27 > 0:24:31and then the kidney takes about another hour or two.
0:24:31 > 0:24:36and so it's two transplants together, it's pretty complicated.
0:24:36 > 0:24:39It's a long day ahead.
0:24:49 > 0:24:52Despite having several surgical procedures in the past,
0:24:52 > 0:24:57Alex's combined liver and kidney transplant is the most high-risk he's faced.
0:25:00 > 0:25:01- OK, thanks.- OK, let's go.
0:25:03 > 0:25:05- See you later.- OK.
0:25:12 > 0:25:15This is the fourth time Daryl has said goodbye to Alex
0:25:15 > 0:25:18prior to major surgery, in the 28 years they've been together.
0:25:24 > 0:25:29It was very hard leaving Alex before the operating room.
0:25:29 > 0:25:33Out of all of it, that's the bit that gets me. Because it's...
0:25:33 > 0:25:38I guess it's a feeling of guilt because you've got health and he hasn't.
0:25:39 > 0:25:43Now it's just a very long, nervous wait.
0:25:45 > 0:25:51I'm very worried, but relieved that at least things are under way,
0:25:51 > 0:25:55because there's nothing worse than continually sitting at home
0:25:55 > 0:25:58thinking, "I wonder if there's going to be a call today."
0:25:58 > 0:26:04The surgeon leading the liver transplant is Andreas Prachalias.
0:26:04 > 0:26:08- This one?- Yeah.- Over there? And then down to the umbilicus.
0:26:08 > 0:26:11- Bypassing the right?- OK.- Yeah?
0:26:11 > 0:26:16Before any transplantation can begin, Andreas and his team
0:26:16 > 0:26:20will need to carefully remove Alex's enlarged liver.
0:26:20 > 0:26:23These are becoming massive, monstrous, in size.
0:26:23 > 0:26:26Organs that compress everything else in the abdomen,
0:26:26 > 0:26:30the stomach, the bowel and, you know, people cannot eat, cannot sleep,
0:26:30 > 0:26:36cannot move, cannot do anything, they don't function as normal individuals.
0:26:36 > 0:26:42Removing his old diseased liver is going to be the tricky part of the operation.
0:26:42 > 0:26:48Once we get that through satisfactorily, then I give a sigh of relief,
0:26:48 > 0:26:53and there's always the chance of a catastrophic bleeding from one of the major vessels.
0:26:58 > 0:27:00The kidney that has been allocated to Michael
0:27:00 > 0:27:02has arrived at his hospital.
0:27:02 > 0:27:04- Morning.- Morning.
0:27:04 > 0:27:09- I've got an organ here, from the couriers.- Thank you.
0:27:09 > 0:27:12- That's great.- Excellent.
0:27:14 > 0:27:16OK, so we've got a blood sample.
0:27:16 > 0:27:22- Yes.- We've got lymph nodes and we've got the spleen.
0:27:23 > 0:27:28- So that's all iced, yeah? - But Michael cannot go straight into the operating theatre.
0:27:28 > 0:27:32As he's having a kidney-only transplant,
0:27:32 > 0:27:36they need to perform further tests before the surgery can go ahead.
0:27:36 > 0:27:42We've taken some blood from him and we've taken some blood sample from the donor as well.
0:27:42 > 0:27:45We set that up in a special test called a cross-match test
0:27:45 > 0:27:49to make sure that, when we put the kidney in, it won't get rejected by him.
0:27:49 > 0:27:54If the cross match is not successful, Michael won't be able to have the transplant.
0:27:54 > 0:27:58And we have a sort of reserve list of people who would be called up in that case,
0:27:58 > 0:28:01and we always, you know, try and use the kidney in somebody else
0:28:01 > 0:28:05if it's not suitable for this particular patient.
0:28:05 > 0:28:10This will take maybe three or four hours to do the testing,
0:28:10 > 0:28:13so only then will they know which recipient
0:28:13 > 0:28:15will be able to have the kidney.
0:28:22 > 0:28:28On the other side of London, Alex's combined liver and kidney transplant operation is well under way.
0:28:29 > 0:28:36After 90 minutes, the full extent of his enlarged polycystic liver is revealed.
0:28:39 > 0:28:42These are all cysts, these bubbles here,
0:28:42 > 0:28:48this is all reasonably normal liver, and these are all cysts here.
0:28:48 > 0:28:52As Alex's liver grew, it became adhered to the organs around it
0:28:52 > 0:28:56so now that and its physical size make it difficult to remove.
0:28:56 > 0:28:58I don't know how we're going to do this,
0:28:58 > 0:29:04but we have to. I'll be a lot happier when we've got that liver out.
0:29:04 > 0:29:10At the moment I'm stressed with all that massive liver hanging here and there.
0:29:10 > 0:29:15Two and a half hours since Alex went into theatre,
0:29:15 > 0:29:19Andreas and his team are close to removing the diseased liver.
0:29:19 > 0:29:22OK, nice, that's it, that's it. OK. Oh, no, no, no.
0:29:26 > 0:29:27OK.
0:29:29 > 0:29:31Oh. That's big.
0:29:32 > 0:29:34Yes, they're going to weigh it now.
0:29:34 > 0:29:38A healthy liver would usually weigh around 1.2 kilograms.
0:29:40 > 0:29:45- I would say er...six kilos. - 6.6 kilos.
0:29:45 > 0:29:47This is just humongous.
0:29:47 > 0:29:50Alex's old liver will be kept for testing.
0:29:58 > 0:30:01I'm Jackie, I'm the duty co-ordinator today, how are you?
0:30:01 > 0:30:04- Hello. - Are you a ball of nerves?
0:30:04 > 0:30:06I'm coming to tell you
0:30:06 > 0:30:09that everything is going fine in theatre.
0:30:09 > 0:30:12The liver is out and we've just weighed it -
0:30:12 > 0:30:15it came out at 6.5, 6.6 kilograms.
0:30:15 > 0:30:17- 6.5 kilos?- 6.5 kilos, yes.
0:30:17 > 0:30:20I'm trying to think - how many pounds is that?
0:30:20 > 0:30:22That's bigger than a baby.
0:30:22 > 0:30:27It is. It looked very ugly, lots of cysts and that on the surface.
0:30:27 > 0:30:30But he's had a little bit of bleeding,
0:30:30 > 0:30:33nothing over and above kind of normal if you like,
0:30:33 > 0:30:37and he's quite stable from the anaesthetic point of view as well.
0:30:37 > 0:30:42It's reassuring to know that, if I can be perfectly blunt,
0:30:42 > 0:30:47that he's still here and that the liver was as big as we suspected.
0:30:47 > 0:30:51- You know?- It's a great weight loss.
0:30:51 > 0:30:54I wouldn't mind that in a day!
0:30:56 > 0:31:01In Alex's surgery, they're ready to transplant the new liver.
0:31:04 > 0:31:08Andreas sews Alex's veins and arteries to the vessels of the new organ.
0:31:12 > 0:31:14- He should be OK now.- OK.
0:31:14 > 0:31:18They're now ready to allow Alex's blood to flow into the liver
0:31:18 > 0:31:20for the first time.
0:31:20 > 0:31:22Right.
0:31:28 > 0:31:32This is the most crucial moment. We're going to reperfuse the liver,
0:31:32 > 0:31:37that's the point that people may die sometimes.
0:31:39 > 0:31:42This phase is called reperfusing,
0:31:42 > 0:31:47when blood flows again through the veins and arteries into the liver.
0:31:47 > 0:31:52And this again is a very, you know, it's a heart-stopping moment.
0:31:52 > 0:31:54Scissors.
0:31:54 > 0:31:59Sometimes that reperfusing may lead even to arrest of the patient.
0:32:01 > 0:32:05Where is the cabin crew? Take your seats for takeoff, as they say,
0:32:05 > 0:32:08this is the moment of truth, yeah.
0:32:08 > 0:32:12- Brian, ready? - Yeah, I'm ready. Ready for landing.
0:32:12 > 0:32:14OK, good. Top clamp is off.
0:32:18 > 0:32:20So the anaesthetist must be on high alert,
0:32:20 > 0:32:25as they usually are. Defcon 2 at least.
0:32:26 > 0:32:30Your eyes mostly and your ear mostly to your anaesthetist
0:32:30 > 0:32:33on how the body and the heart
0:32:33 > 0:32:37and the lungs are taking the stress of reperfusing.
0:32:37 > 0:32:42And you have to have a plan B in your mind if things go horribly wrong.
0:32:42 > 0:32:44OK, bottom clamp is off.
0:32:55 > 0:32:57The liver is reperfused.
0:32:57 > 0:33:00Alex's new liver has been successfully reperfused,
0:33:00 > 0:33:03but it will be many hours before the operation is completed
0:33:03 > 0:33:06and the new kidney is also transplanted.
0:33:13 > 0:33:16In west London, Michael still hasn't heard
0:33:16 > 0:33:21if his five-year wait for a new kidney will soon be over.
0:33:22 > 0:33:26- Hello?- 'Hi, is that Kin Yee?' - Yes, it is.- 'Oh, hi, it's Corinna.'
0:33:26 > 0:33:27Oh, hi, Corinna.
0:33:27 > 0:33:31I'm just calling up with the results of your cross match.
0:33:31 > 0:33:34Oh, fantastic. Hang on a second. Right. So tell me?
0:33:34 > 0:33:37OK, so the first patient on the list, that was all negative.
0:33:37 > 0:33:40- Michael all negative? - Yes, the sample from today.
0:33:40 > 0:33:43Wonderful, that's great, thanks very much, bye.
0:33:43 > 0:33:47- Hello, how are you?- I'm all right.
0:33:47 > 0:33:50- I've got very good news.- Yes?
0:33:50 > 0:33:53It's fine, so the result of the cross match was negative,
0:33:53 > 0:33:58which means that this kidney, hopefully, if we put it into you,
0:33:58 > 0:33:59will not be rejected.
0:33:59 > 0:34:02I'll get the surgeons and let them know that we're sorting you out,
0:34:02 > 0:34:05and we'll probably take you down to theatre in about 15 minutes.
0:34:05 > 0:34:07That's good news!
0:34:07 > 0:34:09OK, so it will be that quickly. OK?
0:34:09 > 0:34:13Yes, very good, very good.
0:34:19 > 0:34:23At Kings, Alex's combined liver and kidney transplant
0:34:23 > 0:34:24has nearly finished.
0:34:26 > 0:34:30Well, this is the liver, nice and pink and red, OK?
0:34:30 > 0:34:34The kidney is down inside there and it also looks nice and pink.
0:34:40 > 0:34:42It may have been a successful transplant,
0:34:42 > 0:34:45but Daryl has been in this position before.
0:34:46 > 0:34:51My worry all the way through has been Alex's intolerance
0:34:51 > 0:34:53to some of the anti-rejection drugs.
0:34:53 > 0:34:58So if he has that intolerance again,
0:34:58 > 0:35:03there's no way back, as far as I can see.
0:35:08 > 0:35:11Because of the trauma of the operation,
0:35:11 > 0:35:15Alex will be kept sedated overnight.
0:35:15 > 0:35:19It's strange, because even though he doesn't know
0:35:19 > 0:35:24that I'm touching his hand, it makes me feel good.
0:35:35 > 0:35:38Michael's kidney transplant will be performed
0:35:38 > 0:35:41by renal transplant specialist Vassilios Papalois.
0:35:41 > 0:35:46It will last four hours and, unlike most transplants, no organs will be removed.
0:35:46 > 0:35:51There is enough room for the existing kidneys to remain in the body.
0:35:51 > 0:35:53The patient's kidneys stay in
0:35:53 > 0:35:57because they just don't function, they don't cause any problem.
0:35:57 > 0:35:59Very rarely, we remove the patient's kidneys.
0:35:59 > 0:36:01Get the new kidney out.
0:36:02 > 0:36:0445 minutes into the operation,
0:36:04 > 0:36:07Vassilios is almost ready to transplant the new kidney.
0:36:07 > 0:36:12It's been kept chilled and in preservation fluid for 11 hours.
0:36:12 > 0:36:15Well, first of all, you see the kidney is pale and grey.
0:36:15 > 0:36:17All the blood has been flushed out of it
0:36:17 > 0:36:19and has been replaced with preservation solution.
0:36:19 > 0:36:22This is the urethra, the pipe that drains the urine
0:36:22 > 0:36:25produced by the kidney to the bladder.
0:36:25 > 0:36:29This is the artery here that give blood to the kidney.
0:36:32 > 0:36:35It looks in good condition, it's well flushed.
0:36:35 > 0:36:40Let's get prepared for reperfusion. More irrigation, please.
0:36:40 > 0:36:44You need to make sure that all the small vessels in the kidney
0:36:44 > 0:36:48will open up and start feeding with blood,
0:36:48 > 0:36:50every single little bit of the kidney.
0:36:50 > 0:36:52But because the kidney was on ice,
0:36:52 > 0:36:56sometimes these vessels are in spasm. You need to break this spasm,
0:36:56 > 0:37:00and the way to do it is to put warm irrigation around the kidney,
0:37:00 > 0:37:03warm water around the kidney to allow for the spasm to break.
0:37:06 > 0:37:09Once the new kidney is connected to Michael's system,
0:37:09 > 0:37:12it fills with his blood.
0:37:12 > 0:37:16So blood flow goes into the kidney and it looks nice and comfortable.
0:37:18 > 0:37:20You see now the difference in the colour?
0:37:20 > 0:37:24The kidney was grey and pale, and now it's nice and pink.
0:37:24 > 0:37:27And despite the fact that it comes from an elderly donor -
0:37:27 > 0:37:30relatively speaking, 65 years old -
0:37:30 > 0:37:33it doesn't look too bad. Looks very good actually.
0:37:33 > 0:37:36There and then, you change somebody's life forever,
0:37:36 > 0:37:38and it happens in front of your eyes.
0:37:38 > 0:37:41You are part of it, which is irreplaceable.
0:37:41 > 0:37:44I don't think there is any other surgical specialty
0:37:44 > 0:37:48that offers you this joy. A lot of stress, but a lot of joy as well.
0:37:52 > 0:37:53Are you feeling all right?
0:37:53 > 0:37:55That's good, you comfortable?
0:37:59 > 0:38:03Within an hour of the transplant finishing, Michael is awake.
0:38:03 > 0:38:04How's your tummy, Michael?
0:38:06 > 0:38:08- All right.- All right?- Yeah.
0:38:08 > 0:38:10Everything went very well. OK?
0:38:10 > 0:38:13The transplant went very, very well.
0:38:14 > 0:38:17Michael is awake and alert and communicating well,
0:38:17 > 0:38:21so he tolerated the operation pretty well.
0:38:21 > 0:38:24The transplant was very successful, he's already making some urine.
0:38:24 > 0:38:27It's early days, but it looks very promising.
0:38:27 > 0:38:29Very, very promising. Very pleased.
0:38:34 > 0:38:37Within days, Michael is out of bed
0:38:37 > 0:38:39and can reflect on the change in his life.
0:38:39 > 0:38:45At one time, I said, "No, a foreign body within your body,
0:38:45 > 0:38:48"it's not right," but I'm grateful for it.
0:38:51 > 0:38:55Yes... Yeah, very grateful.
0:38:59 > 0:39:04The transplant centre that received Penny's heart is 100 miles away.
0:39:07 > 0:39:09At Birmingham's Queen Elizabeth Hospital,
0:39:09 > 0:39:13the heart recipient is recovering from the transplant operation.
0:39:16 > 0:39:18Until a few weeks ago,
0:39:18 > 0:39:2116-year-old Zoe had no idea she had a heart problem.
0:39:23 > 0:39:25It was a bit scary.
0:39:28 > 0:39:32It was sort of like asthma, like shortness of breath
0:39:32 > 0:39:36and then they gave me inhalers,
0:39:36 > 0:39:40but they didn't seem to work.
0:39:40 > 0:39:45So I went back with like...sickness
0:39:45 > 0:39:49and worse breathlessness.
0:39:49 > 0:39:51And then they sent me for an X-ray.
0:39:51 > 0:39:56I remember getting the phone call off the doctor
0:39:56 > 0:40:00to say that you need to get her up to A&E as quickly as you can,
0:40:00 > 0:40:04they need to investigate, she'd got fluid on her heart and lungs.
0:40:04 > 0:40:09They tried to get a blood pressure five times and couldn't get it,
0:40:09 > 0:40:12so they rushed me to ITU
0:40:12 > 0:40:16and, from there, they brought me to here
0:40:16 > 0:40:19and that's all I remember.
0:40:19 > 0:40:24Just pulling up there, and...that's it.
0:40:27 > 0:40:30It was found that her heart function was extraordinarily weak,
0:40:30 > 0:40:36her heart was grossly enlarged, each chamber was failing.
0:40:36 > 0:40:41It was a very rapid deterioration in her condition,
0:40:41 > 0:40:44that took her right to the edge of life.
0:40:46 > 0:40:49Within 24 hours of Zoe being on the urgent transplant list,
0:40:49 > 0:40:52Penny's heart became available.
0:40:54 > 0:40:58Many hearts that we go to in respect of older donors
0:40:58 > 0:41:02will have developed coronary artery disease.
0:41:03 > 0:41:05And it could have happened in Zoe's case
0:41:05 > 0:41:10where we would have to say, "No, it's not safe to proceed.
0:41:10 > 0:41:13In Zoe's case, if that had happened, she wouldn't be here today.
0:41:16 > 0:41:18One minute you've got an active and normal child,
0:41:18 > 0:41:21and then the next minute, a heart transplant.
0:41:21 > 0:41:24You hear of it happening to other people
0:41:24 > 0:41:27but you certainly don't expect it to happen to yourself.
0:41:27 > 0:41:31One minutes she's fine, the next minute she needs a heart transplant.
0:41:31 > 0:41:34- It's frightening.- You just kept thinking you'd wake up.
0:41:34 > 0:41:35< Nightmare. We did.
0:41:39 > 0:41:43I lost my mum at 38 of heart disease
0:41:43 > 0:41:47and, um, she's buried locally, and I'd even thought
0:41:47 > 0:41:50that Zoe would go in with my mum
0:41:50 > 0:41:54and she would wear her prom dress. It was just...
0:41:55 > 0:41:57But luckily...
0:41:58 > 0:42:03I hadn't spoke to anybody about that, but that's what I was thinking.
0:42:03 > 0:42:07I'd planned it, the funeral and the songs we were going to sing, and...
0:42:09 > 0:42:15But, um, we haven't had to... Thank God, so... Sorry.
0:42:15 > 0:42:17And hold your breath in.
0:42:20 > 0:42:21Breathe normally.
0:42:23 > 0:42:25Excellent, well done.
0:42:26 > 0:42:29She has exchanged a desperate situation
0:42:29 > 0:42:30which was going to end her life
0:42:30 > 0:42:35with a transplant which requires constant medication and constant surveillance.
0:42:35 > 0:42:38Thanks to somebody, she's able
0:42:38 > 0:42:43- to take tablets to be healthy, haven't you, hm?- Yep.
0:42:43 > 0:42:47It's not unusual for young recipients
0:42:47 > 0:42:49to receive hearts from older donors
0:42:49 > 0:42:53and, in Zoe's case, her donor was nearly 50 years older than her.
0:42:53 > 0:42:56If there was no problem with donor supply,
0:42:56 > 0:43:02clearly, you would select a young, very healthy donor
0:43:02 > 0:43:06with minimal risk factors for every transplant. It's just not possible.
0:43:12 > 0:43:16When she's back home and she's better,
0:43:16 > 0:43:19then we'll be able to start thinking about
0:43:19 > 0:43:25who actually gave us the heart and, how will we ever repay them?
0:43:28 > 0:43:30Following Penny's funeral,
0:43:30 > 0:43:32her family, like all families that have donated,
0:43:32 > 0:43:37receive a letter telling them about the people who have benefited from Penny's donation.
0:43:39 > 0:43:43- Want me to read it out?- Yes.- OK.
0:43:43 > 0:43:47"Dear Cyril, as I write to you...
0:43:47 > 0:43:50"I realise that it's only been a short time since Penny died.
0:43:50 > 0:43:55"I know that you and Emma must miss her very much. I am so sorry for your loss.
0:43:55 > 0:43:58"You know I spent only a short time with you.
0:43:58 > 0:43:59"I could tell by listening to you
0:43:59 > 0:44:02"just how special a person Penelope was to you both,
0:44:02 > 0:44:04"but I hope that you will find some comfort
0:44:04 > 0:44:07"in knowing how your gift has helped so many people."
0:44:07 > 0:44:08It's Penny's gift.
0:44:08 > 0:44:11"I am pleased to inform you that
0:44:11 > 0:44:15"a 16-year-old girl received an urgent, life-saving heart transplant.
0:44:15 > 0:44:19"This young girl was exceptionally ill prior to her transplant operation
0:44:19 > 0:44:22"and was being cared for on the Intensive Care Unit.
0:44:22 > 0:44:24"I can only imagine the relief
0:44:24 > 0:44:27"the parents, brothers and sisters will be feeling
0:44:27 > 0:44:31- "as a result of her steady progress to recovery."- She's so young.
0:44:31 > 0:44:35A 16-year-old, a young child, I mean...she's got a life.
0:44:35 > 0:44:37It's just amazing.
0:44:37 > 0:44:41"I am also pleased to tell you that a 52-year-old gentleman
0:44:41 > 0:44:44"has received a life-saving liver and kidney transplant.
0:44:44 > 0:44:47"He is making steady progress and, since his transplant,
0:44:47 > 0:44:49"he's not needed kidney dialysis.
0:44:49 > 0:44:51"I understand he is very grateful
0:44:51 > 0:44:54"for this chance to have a better quality of life.
0:44:54 > 0:44:57"Another man aged 66 has also received a kidney transplant..."
0:44:57 > 0:45:00I'm not doing well, am I?
0:45:00 > 0:45:03"Thanks to your kindness, these two patients and their families
0:45:03 > 0:45:05"can continue to live their lives
0:45:05 > 0:45:08"free of the constraints that kidney dialysis can bring."
0:45:08 > 0:45:10Wow.
0:45:12 > 0:45:14It kept thanking us, it's not us.
0:45:25 > 0:45:27So imagine that they've suddenly been called in,
0:45:27 > 0:45:32they've got a match, and their life has changed overnight.
0:45:34 > 0:45:38- You know, it's just incredible. - Just amazing.
0:45:44 > 0:45:47After his combined liver and kidney transplant,
0:45:47 > 0:45:51Alex is up and he's beginning the slow process of recovery.
0:45:51 > 0:45:56- And the right leg to start with now? - Go with your good leg now.- Yeah.
0:46:00 > 0:46:02Sprint at the end.
0:46:03 > 0:46:08It will be easier, it will be easier, every day, the better you are.
0:46:08 > 0:46:12I did more than I thought I'd be able to.
0:46:13 > 0:46:18So, obviously, each day, my body's recovering more and more
0:46:18 > 0:46:21and I'm getting more energy and strength.
0:46:23 > 0:46:24It was good.
0:46:24 > 0:46:27You passed your exam.
0:46:27 > 0:46:32Although the new liver and kidney have been successfully implanted,
0:46:32 > 0:46:37Alex feels the responsibility of having a second transplant.
0:46:37 > 0:46:39I felt with the first kidney
0:46:39 > 0:46:43that I had to do everything to give it a chance to work.
0:46:47 > 0:46:52Yeah. When things start to go wrong, you carry... You do carry guilt
0:46:52 > 0:46:55because, at the end of the day,
0:46:55 > 0:46:59someone's died to give you that chance,
0:46:59 > 0:47:04and you feel an affinity with that family
0:47:04 > 0:47:06and you really want it to work
0:47:06 > 0:47:12because you want to make something positive come out of their grief.
0:47:12 > 0:47:18And we're very hopeful that, this time, we'll be OK.
0:47:18 > 0:47:21I feel like I will be able to get back to
0:47:21 > 0:47:24as near a normal life as I had before.
0:47:24 > 0:47:25Now I feel...
0:47:29 > 0:47:32..just... there's things that I can do again.
0:47:51 > 0:47:53Transplantation is not a sprint.
0:47:53 > 0:47:56As with everything else in medicine, it's not magic
0:47:56 > 0:47:59and you need a very proper and very tight follow-up.
0:47:59 > 0:48:03It's something that's going on for years and requires proper monitoring
0:48:03 > 0:48:05to ensure things are going well in the long run.
0:48:05 > 0:48:08Michael has spent a month in hospital
0:48:08 > 0:48:11and is well enough to be discharged.
0:48:11 > 0:48:14Like everyone who's had an organ transplant,
0:48:14 > 0:48:17he will need to take a combination of drugs for the rest of his life.
0:48:17 > 0:48:22I would first of all start with the most important medication -
0:48:22 > 0:48:24the immunosuppressant.
0:48:24 > 0:48:27- That's right, yeah.- Yeah?- Yeah.
0:48:27 > 0:48:32Those ones you have no excuse whatsoever to miss them
0:48:32 > 0:48:37because they prevent your kidneys from rejecting, yeah?
0:48:37 > 0:48:39The natural reaction of our body
0:48:39 > 0:48:43when something new and foreign is introduced is to fight against it.
0:48:43 > 0:48:47For example, if you get an infection from a virus or something, or a bug,
0:48:47 > 0:48:51your immune system, your defence mechanisms tries to fight it.
0:48:51 > 0:48:55When you do a transplant, your immune system doesn't know that this is for the good of the patient,
0:48:55 > 0:48:59they see the kidney as a foreign body and attack it, OK?
0:48:59 > 0:49:04If you don't treat this, if you are not prepared to treat this, it will destroy it, it will reject it.
0:49:04 > 0:49:07So these ones, you take them four times.
0:49:07 > 0:49:10- Four times a day, yes. - And you take...
0:49:10 > 0:49:13Immunosuppressants knock down your defence mechanisms.
0:49:13 > 0:49:17The good news is, of course, that you don't reject your kidney.
0:49:17 > 0:49:18On the other hand,
0:49:18 > 0:49:21it makes you more susceptible to infection for example or cancer.
0:49:21 > 0:49:245ml. And one drop is 1ml.
0:49:24 > 0:49:26- Right.- Yeah?
0:49:26 > 0:49:28You have to get the balance right
0:49:28 > 0:49:31to get the benefit of preventing rejection,
0:49:31 > 0:49:33but none of the side affects.
0:49:33 > 0:49:37And you have one gram, which is two tablets, four times a day.
0:49:37 > 0:49:39- Four times a day. - Four times, yes.
0:49:41 > 0:49:43I'll have to learn to get used to it!
0:49:47 > 0:49:51- You are going home?- Yes, thank you very much.- Congratulations.
0:49:51 > 0:49:52Even with medication,
0:49:52 > 0:49:5715% of organ recipients will suffer some rejection in the first year.
0:49:57 > 0:49:59Right, bye-bye.
0:50:01 > 0:50:03Since the transplant six weeks ago,
0:50:03 > 0:50:06Zoe has only been allowed home for a few days,
0:50:06 > 0:50:08and she's being closely monitored.
0:50:08 > 0:50:10Transplantation has its dangers,
0:50:10 > 0:50:15it has its hazards at every step of the way,
0:50:15 > 0:50:17and we try to steer them through that.
0:50:17 > 0:50:21- Nice to see you.- Hiya. - Please have a seat.
0:50:21 > 0:50:25This is the new heart which is working nicely for you,
0:50:25 > 0:50:28and that's why you're feeling better and you are able to do
0:50:28 > 0:50:31much more than what you were able to do before transplant.
0:50:31 > 0:50:34Your heart is working well, OK.
0:50:34 > 0:50:39But Zoe has been showing signs that she's rejecting the new heart
0:50:39 > 0:50:41and has been given stronger immunosuppressants.
0:50:41 > 0:50:44I know I shouldn't look on the dark side,
0:50:44 > 0:50:47but if she was to reject today,
0:50:47 > 0:50:51would she have to come back into hospital?
0:50:51 > 0:50:55If today's biopsy does show there is still some residual rejection,
0:50:55 > 0:50:57then we will have to admit you again
0:50:57 > 0:51:00and give you a bit more stronger immunosuppression.
0:51:00 > 0:51:02Right, OK.
0:51:02 > 0:51:07And with that, you will have to be in hospital for at least seven days.
0:51:07 > 0:51:09I don't want to scare you, OK?
0:51:09 > 0:51:14In 95% of the patients, last week's treatment would have done the job.
0:51:18 > 0:51:19Later that day,
0:51:19 > 0:51:23the test results mean that Zoe IS readmitted for further treatment.
0:51:25 > 0:51:28She's all right, she's a bit fed up,
0:51:28 > 0:51:29but she's all right.
0:51:29 > 0:51:33Because she's well in herself, so it's difficult,
0:51:33 > 0:51:36it's hard for her to get her head around it, in't it? So... Yeah.
0:51:38 > 0:51:41All right, Nan, bye. Bye-bye.
0:51:42 > 0:51:44I mean we realise now, like,
0:51:44 > 0:51:48we're going to be backwards and forwards for a long time.
0:51:48 > 0:51:53But like when we left here the first time, a couple of weeks ago,
0:51:53 > 0:51:55we just thought it was all over type of thing.
0:51:55 > 0:52:01I did think that it was going to be a cure and it's shocked me...
0:52:01 > 0:52:05it is really frightening, really.
0:52:05 > 0:52:10Hopefully, we're having all these downsides to begin with
0:52:10 > 0:52:12and then we can move on.
0:52:12 > 0:52:15So we can get home again.
0:52:15 > 0:52:17Yeah, I just want to go back home.
0:52:19 > 0:52:23I feel fine, so I want to get back to normal.
0:52:33 > 0:52:37It's been six weeks since Penny's death.
0:52:37 > 0:52:38Emma and her fiance Matt
0:52:38 > 0:52:43are spending as much time as possible with her dad, Cyril.
0:52:43 > 0:52:47I think he's doing OK. Well, I say OK. What I mean is
0:52:47 > 0:52:52we're getting out of bed, we're having a shower, we're eating, we're talking to people,
0:52:52 > 0:52:56we're leaving the house, and that's as OK as you can be really.
0:52:56 > 0:52:59I'm constantly thinking about her,
0:52:59 > 0:53:03and it hurts in a way because your brain just doesn't stop.
0:53:06 > 0:53:12Penny and myself, we always had this view that the surviving spouse
0:53:12 > 0:53:15has got to get on with their life.
0:53:16 > 0:53:18She would be living life to the full.
0:53:18 > 0:53:24I haven't quite got there yet, but it's not far away, um...
0:53:24 > 0:53:26Yes, we've got to get on.
0:53:26 > 0:53:30Just a bit more, right, I'm just going to get...
0:53:30 > 0:53:34For Penny's family, the donation of her organs has been a positive experience.
0:53:34 > 0:53:37We don't feel any different because she donated her organs.
0:53:37 > 0:53:40For us, it makes no difference, she didn't... As Dad said,
0:53:40 > 0:53:43they're on loan to her and now they've passed on to someone else.
0:53:46 > 0:53:49I suppose we weren't particularly precious over...
0:53:49 > 0:53:53what she had with her when she was cremated.
0:53:53 > 0:53:57We don't have memories of her heart or her liver or her kidney.
0:53:57 > 0:53:58We have memories of her.
0:54:02 > 0:54:05We've, in a way, lost a part of the future,
0:54:05 > 0:54:10but they've got themselves a future which they didn't expect to have.
0:54:11 > 0:54:17So whilst I feel slightly cheated, I feel this big plus side as well.
0:54:21 > 0:54:25Today, Zoe and her family will get the results of her latest tests
0:54:25 > 0:54:28to see if she's still rejecting her new heart.
0:54:28 > 0:54:30So what do you want to hear?
0:54:33 > 0:54:35So you had your biopsy today
0:54:35 > 0:54:38and, congratulations, there's no rejection.
0:54:38 > 0:54:40Oh, God almighty, thank God for that!
0:54:40 > 0:54:44Brilliant. Go home, thank God for that.
0:54:44 > 0:54:51I'm going home to see my friends and get back to normal, hopefully!
0:54:51 > 0:54:54Bye! See you, bye, ta-ra.
0:54:56 > 0:54:59- Bye, see you.- Hope you won't see us for a long time!
0:54:59 > 0:55:01No, thank you, see you!
0:55:04 > 0:55:08'No-one knows whether she's going to live healthy'
0:55:08 > 0:55:12or whether she's going to reject again.
0:55:12 > 0:55:14That's what it is, not knowing.
0:55:14 > 0:55:17So you've just got to let her live, do what she wants to do.
0:55:17 > 0:55:19Is it nice to be back home, Zo?
0:55:19 > 0:55:22- Yep.- Your own bed.- Yeah!
0:55:24 > 0:55:28If it hadn't have been for the heart donation...
0:55:28 > 0:55:33I don't know whether she'd be here now. I don't know.
0:55:33 > 0:55:36- We're one of the lucky ones, aren't we?- Yeah.- We are.
0:55:36 > 0:55:39At least we've got Zo now, haven't we?
0:55:47 > 0:55:51Day-to-day existence has changed dramatically for Michael.
0:55:51 > 0:55:55Despite several spells back in hospital, his new kidney
0:55:55 > 0:55:59has given him freedom following seven years of dialysis.
0:56:00 > 0:56:03I've got half my life back, you could say.
0:56:05 > 0:56:09Apart from the two days I've got to go to clinic to see the doctors,
0:56:09 > 0:56:12the rest of the time is your own.
0:56:12 > 0:56:17I wouldn't be sitting here now playing dominoes.
0:56:18 > 0:56:23It's an exciting time for me. Free, free as a bird.
0:56:25 > 0:56:30Since having his combined liver and kidney transplants,
0:56:30 > 0:56:33Alex has been in and out of hospital,
0:56:33 > 0:56:35but the anti-rejection drugs are working.
0:56:35 > 0:56:39The difference in him now to what he was pre-transplant
0:56:39 > 0:56:41is absolutely unbelievable.
0:56:41 > 0:56:45Not just in appearance - there's a physical appearance -
0:56:45 > 0:56:47but it's also enthusiasm.
0:56:47 > 0:56:49Yeah, you're just more alert.
0:56:49 > 0:56:53- Yep. I'm getting more out of life basically.- Yeah.
0:56:53 > 0:56:58Rather than sort of like being in a daze for 24 hours a day.
0:56:59 > 0:57:01I feel as if I've woken up.
0:57:02 > 0:57:05- How fast do you want to walk? - Not too fast!
0:57:05 > 0:57:10Although they are moving forward, they will never forget the donation.
0:57:13 > 0:57:15On behalf of their loved one, they've made a donation,
0:57:15 > 0:57:18Alex has benefited. Just so thankful
0:57:18 > 0:57:24that there are people that will do that. I just wish there were more
0:57:24 > 0:57:27because so many people that I've met over this experience
0:57:27 > 0:57:33who aren't going to survive because there aren't the organs for them.
0:57:33 > 0:57:37And it's so heartbreaking.
0:57:41 > 0:57:45I believe that people remain reluctant to reflect upon
0:57:45 > 0:57:50what might happen to them at their death
0:57:50 > 0:57:53and, therefore, there is a reluctance to discuss
0:57:53 > 0:57:55whether you could donate at that time.
0:57:58 > 0:58:02I strongly believe and advocate that we should make transplantation
0:58:02 > 0:58:05and organ donation part of people's culture.
0:58:05 > 0:58:08When people know about it, they will not say no.
0:58:08 > 0:58:12In an ideal world, as I would like to dream, we shouldn't have
0:58:12 > 0:58:15transplant coordinators approaching the families.
0:58:15 > 0:58:19The families should approach the doctor and say, "We want to donate".
0:58:21 > 0:58:23For us it was made easy, we discussed it.
0:58:23 > 0:58:28But if we hadn't, I don't know how I would have felt in that situation.
0:58:28 > 0:58:31We look at the fact that somewhere, she is saying,
0:58:31 > 0:58:34"Good on you, you've done what I wanted."
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