Transplant

This programme contains some scenes which some viewers may find upsetting

In Britain, over 10,000 people are in need of an organ transplant.

Each day, three will die because of the lack of donors.

It's Carol from the London team here, I'm offering you a heart from St George's.

For the first time, this film shows the remarkable story

of how a single organ donor can change the lives of many others.

The heart's stopped.

'You are aware that it's the end of a life, but then again'

you realise that it's the beginning of so many other lives from this one life.

With unprecedented access, we follow the incredible process

from one person's death to multiple transplants.

This is the most crucial moment, we are going to re-perfuse the liver.

You have an organ which was in one person, you take it out,

practically, for a few hours, it's dead.

And then you transplant it, it comes back to life. It is a miracle happening in front of your eyes.

Organ donation is based on strict anonymity.

In this film, the donor's family and the organ recipients

have agreed to waive their anonymity to allow us to tell their stories.

One minute you've got an active and normal child,

and the next minute she's needing a heart transplant, it's frightening.

You do carry guilt because, at the end of the day, someone's died to give you that chance.

Hold on, good girl!

Yes! I did it!

Ten days ago, following a brain haemorrhage,

65-year-old Penny was admitted to St George's Hospital in London.

Penny was sitting up on a bed upstairs and just saying, "I've got a headache."

Then minutes later

she was absolutely screaming in pain and asked for an ambulance.

And that was a week and a half ago.

Mum was in A&E and erm... She was...she was all right.

She was on oxygen, but she could talk, and you know, we were joking about, you know,

we made a few comments about a silver-haired doctor, as girls do.

There was a point she wouldn't wake up, and she'd bled again.

They take you into a room and there's a table with a box of tissues.

At that point, you know it's really bad.

They were just trying to bring her back, but they failed unfortunately.

Not their fault, she just was too far gone.

This morning at St George's, Penny was declared brainstem dead.

Of the 1,500 people who die each day in the UK, Penny is one of just three who become organ donors.

My name's Carol, I'm a specialist nurse for organ donation,

could you page the cardiology registrar for me?

Neuro ITU, yeah, bed seven.

Penny had made it clear to her family that when she died she wished to donate her organs.

After being approached by a specialist nurse, her family are supporting her wishes.

It is a very sad job at the beginning of the process,

but it's also a really rewarding job because, you know, I'm still saving lives.

Not my donor's life, but I'm helping to save somebody else's life, somewhere else.

I have consent for heart, liver, kidneys, pancreas.

Working from a nationwide priority list, Carol alerts dedicated transplant centres

that organs are available for transplantation.

The donation process she is starting will eventually involve over 150 people.

I'm offering you a heart from St George's.

65-year-old female.

Anybody could become an organ donor regardless of age,

but for certain organs, there are strict criteria.

For example, if you were to donate your heart you have to be 65 and under.

If you were to donate your kidneys, you could be any age, into your 70s, sometimes into your 80s.

Although Penny's on the upper age limit for heart donation,

prior to her brain haemorrhage she was fit and healthy.

She looks re...

I'm telling you, she looks absolutely amazing.

To look at her, you wouldn't think she was 65, she looks wonderful.

While Carol finds suitable recipients for the organs,

Penny continues to be looked after on the intensive care unit.

Although she's been declared brainstem dead, her heart is being kept beating artificially

to ensure that the organs are viable for transplantation.

If your brainstem doesn't work, you'll lose the ability to breathe.

If you lose the ability to breathe, your heart stops.

Nowadays, with the technology, we can keep somebody breathing

artificially, and keep the heart pumping artificially,

not forever, but prolong this period beyond death.

Penny's organs still need to be retrieved as soon as possible,

as they will start to deteriorate the longer she is on the machine.

Because organ donation is time-critical,

across the country, specialist surgical teams are on-call 24 hours a day

ready to perform organ-retrieval operations.

Carol has mobilised two of these retrieval teams to come to St George's.

The operation is performed by specialist transplant surgeons.

They come from the transplant centres, they're the ones that do heart transplants

or they do liver transplants and they're experts in this field.

-Are you all right there?

-Oh, yeah.

-Do you want me to carry anything?

-No, you're all right.

The cardiothoracic team have come from Birmingham's Queen Elizabeth Hospital

where a recipient is in desperate need of a new heart.

The other surgical team have come just a few miles from King's College Hospital in southeast London.

They will retrieve the liver and kidneys.

-No pancreas.

-No pancreas, no.

Sorry, last little favour, one kidney we are taking...

-You're taking one kidney, Hammersmith is having the other one.

-Thank you.

-OK?

-I'll be with you as soon as possible to hand over.

-No problem.

With both surgical teams on site, they can now prepare to retrieve Penny's 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 she said they had to be.

There was no maybe - as far as she was concerned they had to be.

Like Penny, most people support organ donation in principle,

but 40% of families still decide not to donate their loved ones' organs at the time of death.

She always wanted me to be the one to make sure that it happens

because she was always concerned that Dad wouldn't be strong enough

to say yes at the time, and it turns out actually, at the time,

he was, you know, he knew her wishes and he was very strong,

but you don't know how people will be at the time when they're asked,

and usually when you're asked it's the same time you're told your loved one is dying or has died.

Across the country, the patients identified as suitable recipients

for Penny's organs are called into hospital and prepared for the possibility of transplant surgery.

One patient is called into King's College Hospital in southeast London.

A specialist liver centre, it treats patients from across the country.

Tonight, Alex and his wife Daryl have travelled over 200 miles to get to King's.

I've only just grown it back!

52-year-old Alex works in the motor trade. His life has been seriously restricted

as he's been ill on-and-off for 20 years.

He's already had one failed kidney transplant.

Although you prepare yourself for it, you know it's going to happen, but it's still...

It's still a hell of a shock when that call comes.

And you go through such a huge range of emotion, it's incredible.

This time, Alex desperately needs a combined liver and kidney transplant.

Even though he's been blood-matched to Penny, it's too early to be sure

her organs will be in good enough condition for transplantation.

We're hoping theatre will be around eight o'clock in the morning, OK?

The liver and the kidneys, they're being retrieved at the moment,

so we're still waiting to hear from the surgeons,

so it does mean we won't be able to tell you absolutely we'll go ahead until later on this morning.

-Right.

-OK?

-Yep. That's OK.

I'll be back down a bit later to let you know how things are, but...

I feel totally tied up in knots on the inside.

Erm... Excitement.

Erm... Terror.

'Because I've got hope,

because hopefully this will help Alex.

I've got guilt because, at the end of the day, someone has died to make this possible.

I've got fear that things won't work, and that, potentially, I could lose him.

It's 2:30 in the morning, and at the donor hospital

the surgical teams are ready to begin the retrieval of Penny's organs.

It's going to take a few hours now. It's not just quick in-you-go and grab everything and run again.

The key thing is retrieving the organs safely without damages,

I know that there's a patient

waiting at the other end in my base hospital for a liver

and he's not going to get the liver

if I damage it, so that is always a pressure on me to do the job well.

It looks like any ordinary surgery.

We try very much to respect the donor as much as possible,

you know, treat the body with respect.

You are aware that it's the end of a life,

but then if you realise that it's the beginning of so many other lives from this one life.

Penny's heart will be kept artificially beating until they're ready to remove the organs.

First, the surgeons need to check for any obvious signs of disease.

My anxiety is, am I going to find any unexpected surprises?

I have found previously healthy patients who have been donors

and are opened up to find there are tumours or cancer.

In every case I look for it, to see they don't exist.

Once Mansoor, the abdominal surgeon, has made his initial assessment of the liver and kidneys,

Abdul, the cardiothoracic surgeon, joins him at the operating table.

Most of the time when you open people even younger than that donor

you find coronary disease.

I was expecting a thickened heart from high blood pressure,

sometimes the heart may be not functioning well because of ageing.

'I wasn't sure that heart would be useable.'

Once both surgeons are happy there are no immediate problems

they're ready to stop Penny's heart artificially beating and retrieve the organs.

But this is a critical stage, as the organs will begin to deteriorate rapidly

and the heart must be transplanted within four hours of leaving the body.

To transport the organs as quickly as possible,

specialist transport companies are on-call around the clock to drive or fly them anywhere in the country.

You're hoping for the green light on the helicopter, just after five.

-Blue light on the... Yeah.

-Yeah, and...

..and I've got to check that the driver's around as well. OK then.

At this vital stage, emergency transport for the organs must be standing by.

The retrieval will not proceed until everything is in place.

-Right, hopefully we're getting the green light from the helicopter just after five.

-Yes.

As soon as we get that, then we can prepare to retrieve the heart.

-OK, excellent.

-As soon as we get that we're on the go.

A few miles away, Alex is still waiting to hear

if the organs will be viable for his combined liver and kidney transplant.

I had a kidney transplant last year,

but unfortunately it didn't work for me and I had some other problems

and infections and I had to have that removed.

Alex has polycystic kidney disease,

which means his kidney is covered with cysts and no longer functions.

He's been on dialysis for three years.

The disease is now affecting his liver as well,

causing it to swell to six times its normal size.

My liver has grown to a certain extent that it's pressing on a main artery

and it's not really the functioning of the liver.

It's the shape and size of it that's causing me problems,

and that's why I'm having a liver transplant as well.

At the donor hospital, they wait to hear that the helicopter is ready

so that they can begin the retrieval of the organs.

PHONE RINGS

Hi, Sharon.

We can clamp, excellent, thank you very much. Bye.

-Everybody ready?

-Yes.

-OK, new line is in.

Finally they're given the go-ahead to stop the heart.

The next few minutes are critical.

Any problems in removing the organs could affect the future of the waiting recipients.

The team stop the blood flow to the heart.

Dead on 22 clamped, OK? 05.22.

The heart's stopped.

We perfuse the organs with cold fluid

making the heart more cold, to protect it and preserve it longer.

You have limited time to keep them alive, those organs.

The ice-cold preservation fluid replaces the blood in the organs

prolonging the amount of time they can be disconnected from a blood supply.

At 5:40 in the morning, the first organ is removed - the heart.

The surgeons won't know for certain the organs are viable for transplantation

until they're thoroughly examined outside of the body.

'The heart looks like a heart of a 20-year-old person,'

I didn't believe, I felt this is the wrong patient we are doing!

She had a good heart, that woman.

'I informed the recipient centre immediately that the heart is a useable heart and is a good heart.'

To keep the organs healthy en route to the transplant centres, they're chilled with ice.

-Thank you very much.

-OK.

-Thank you so much.

-Thank you very much, safe journey.

The life of the patient in Birmingham depends on the safe and timely delivery of the heart.

The specialist organ transport team are authorised to travel under emergency blue lights.

We're just leaving St George's now with the heart on board

and we're going to Regents Park for the rendezvous with the helicopter, thank you.

It takes 15 minutes for the ambulance to reach Regents Park in central London,

where the chartered helicopter has been given special clearance to land.

The heart begins its final journey to Birmingham by air.

-'Thanks.'

-Bye for now.

The next organ to be retrieved is the liver, which has been allocated to Alex.

Reasonable liver, non-fatty, it'll probably be about 1,100 grams,

it's well perfused, no other injuries, no tear or anything else. OK.

It's 6:15 and the news about the organs is relayed to the coordinator at King's,

where Alex is waiting for a new liver and kidney.

-Hi, Wendy.

-'Hi, Ruby, have you got some information?'

-Yes.

'It's a good liver, well perfused.'

'No injuries, no damage.'

OK, and the kidney's all right?

-It is a little small, but they're OK.

-He says that the kidneys are a little small but they're OK,

-because the patient's not very big, they are...

-Yeah, sure.

-Is the anatomy normal on the kidney, the left kidney?

-Yes.

Anatomy is normal, no injuries.

-Thanks, Ruby. Can you just let me know when you're leaving, please?

-I'll let you know, yes.

-OK, thanks.

-Thanks, Wendy.

-'Thank you.'

-Bye.

-'Bye.'

Well, looks good, but the consultant makes the final decision.

I'll just give him the information and then we can move ahead.

We've got up to about 8-12 hours to transplant the liver,

but obviously the sooner you transplant any organ, the better it will function.

Across London, a patient in another hospital has been allocated Penny's other kidney.

The Hammersmith Hospital treats people with acute kidney failure.

One of their patients, 66-year-old Michael, is one of the potential matches for a transplant.

He suffers from high blood pressure and diabetes.

I use my walking stick because it helps me to get around...

..you know, and when you get on a bus they're very kind,

they always give you a seat, you know,

because you've got a stick, you know, so I mustn't complain about that.

Before he retired, Michael worked on the railways,

but since his kidneys failed seven years ago,

he's been having dialysis three times a week to keep him alive.

He depends totally on dialysis.

To put it simply, when you're on dialysis and you have renal failure

you live in the hospitals and you go home every now and then.

When you have a transplant, you live at home and have a good life, and go to the hospitals every now and then.

'Every year on dialysis makes him more weak and frail actually, which increases the chances of dying.

So it's not a very pleasant situation. Anything but that -

a very difficult situation - so this kidney's a blessing for him.

It's a very big day, and the thing most patients tell me when they get the phone call

is that, first of all, they just can't believe it

and they sort of shake,

and sometimes, you know, they get very panicky and very nervous

because sometimes they've been waiting for many, many years.

Well, I've been on the list about four to five years.

It is a long time.

But, er...

You can't rush these things because you've got to wait for someone to have a misfortune,

you could say, for a kidney to come up, you know.

-Right kidney?

-Yes.

-Right kidney.

Thank you.

Left kidney, thank you.

20 hours since Penny was pronounced dead,

the last of her donated organs are about to leave the donor hospital.

The kidney allocated to Michael will be transported by a courier.

-Kidney to go to the Hammersmith.

-Yes.

-That's correct, OK, they're expecting you.

Out of all the donated organs, the kidneys can last the longest out of the body -

up to 36 hours - before being transplanted.

It's the first time I'm actually taking an organ,

it's my third day on the job, so no pressure there.

The other kidney and the liver will be travelling with the surgical retrieval team

the few miles to King's, where Alex is waiting.

They have a maximum of 12 hours to transplant the liver.

-Wendy?

-'Yes?'

We've just left the hospital, so a few minutes, I don't know, 20 minutes?

-20 minutes, I think.

-That's fine. OK, thanks. OK, bye.

-(I don't want to wake him up, but they are going to go ahead. OK?

-Yep.

-(Everything's fine, OK?)

-What time's he need to get up?

The anaesthetist will be around about eight, just after eight to take him to theatre.

It's quarter past seven in the morning, and at the donor hospital

the body has been closed and the organ-retrieval operation is over.

Carol is performing last offices, where the body is cleaned and the hair is washed

before being returned to the family for the funeral service.

It's lovely and peaceful now, and this is how it should be at this time.

I like it when it's like this, everything's over.

And you can take your time, you know, there's no mad rush or anything,

you know, you can just take your time and do a good job.

The liver and kidney for Alex are about to arrive at King's College Hospital, ready for the transplant.

The liver itself will take about five to six hours of plumbing it in,

and then the kidney takes about another hour or two.

and so it's two transplants together, it's pretty complicated.

It's a long day ahead.

Despite having several surgical procedures in the past,

Alex's combined liver and kidney transplant is the most high-risk he's faced.

-OK, thanks.

-OK, let's go.

-See you later.

-OK.

This is the fourth time Daryl has said goodbye to Alex

prior to major surgery, in the 28 years they've been together.

It was very hard leaving Alex before the operating room.

Out of all of it, that's the bit that gets me. Because it's...

I guess it's a feeling of guilt because you've got health and he hasn't.

Now it's just a very long, nervous wait.

I'm very worried, but relieved that at least things are under way,

because there's nothing worse than continually sitting at home

thinking, "I wonder if there's going to be a call today."

The surgeon leading the liver transplant is Andreas Prachalias.

-This one?

-Yeah.

-Over there? And then down to the umbilicus.

-Bypassing the right?

-OK.

-Yeah?

Before any transplantation can begin, Andreas and his team

will need to carefully remove Alex's enlarged liver.

These are becoming massive, monstrous, in size.

Organs that compress everything else in the abdomen,

the stomach, the bowel and, you know, people cannot eat, cannot sleep,

cannot move, cannot do anything, they don't function as normal individuals.

Removing his old diseased liver is going to be the tricky part of the operation.

Once we get that through satisfactorily, then I give a sigh of relief,

and there's always the chance of a catastrophic bleeding from one of the major vessels.

The kidney that has been allocated to Michael

has arrived at his hospital.

-Morning.

-Morning.

-I've got an organ here, from the couriers.

-Thank you.

-That's great.

-Excellent.

OK, so we've got a blood sample.

-Yes.

-We've got lymph nodes and we've got the spleen.

-So that's all iced, yeah?

-But Michael cannot go straight into the operating theatre.

As he's having a kidney-only transplant,

they need to perform further tests before the surgery can go ahead.

We've taken some blood from him and we've taken some blood sample from the donor as well.

We set that up in a special test called a cross-match test

to make sure that, when we put the kidney in, it won't get rejected by him.

If the cross match is not successful, Michael won't be able to have the transplant.

And we have a sort of reserve list of people who would be called up in that case,

and we always, you know, try and use the kidney in somebody else

if it's not suitable for this particular patient.

This will take maybe three or four hours to do the testing,

so only then will they know which recipient

will be able to have the kidney.

On the other side of London, Alex's combined liver and kidney transplant operation is well under way.

After 90 minutes, the full extent of his enlarged polycystic liver is revealed.

These are all cysts, these bubbles here,

this is all reasonably normal liver, and these are all cysts here.

As Alex's liver grew, it became adhered to the organs around it

so now that and its physical size make it difficult to remove.

I don't know how we're going to do this,

but we have to. I'll be a lot happier when we've got that liver out.

At the moment I'm stressed with all that massive liver hanging here and there.

Two and a half hours since Alex went into theatre,

Andreas and his team are close to removing the diseased liver.

OK, nice, that's it, that's it. OK. Oh, no, no, no.

OK.

Oh. That's big.

Yes, they're going to weigh it now.

A healthy liver would usually weigh around 1.2 kilograms.

-I would say er...six kilos.

-6.6 kilos.

This is just humongous.

Alex's old liver will be kept for testing.

I'm Jackie, I'm the duty co-ordinator today, how are you?

-Hello.

-Are you a ball of nerves?

I'm coming to tell you

that everything is going fine in theatre.

The liver is out and we've just weighed it -

it came out at 6.5, 6.6 kilograms.

-6.5 kilos?

-6.5 kilos, yes.

I'm trying to think - how many pounds is that?

That's bigger than a baby.

It is. It looked very ugly, lots of cysts and that on the surface.

But he's had a little bit of bleeding,

nothing over and above kind of normal if you like,

and he's quite stable from the anaesthetic point of view as well.

It's reassuring to know that, if I can be perfectly blunt,

that he's still here and that the liver was as big as we suspected.

-You know?

-It's a great weight loss.

I wouldn't mind that in a day!

In Alex's surgery, they're ready to transplant the new liver.

Andreas sews Alex's veins and arteries to the vessels of the new organ.

-He should be OK now.

-OK.

They're now ready to allow Alex's blood to flow into the liver

for the first time.

Right.

This is the most crucial moment. We're going to reperfuse the liver,

that's the point that people may die sometimes.

This phase is called reperfusing,

when blood flows again through the veins and arteries into the liver.

And this again is a very, you know, it's a heart-stopping moment.

Scissors.

Sometimes that reperfusing may lead even to arrest of the patient.

Where is the cabin crew? Take your seats for takeoff, as they say,

this is the moment of truth, yeah.

-Brian, ready?

-Yeah, I'm ready. Ready for landing.

OK, good. Top clamp is off.

So the anaesthetist must be on high alert,

as they usually are. Defcon 2 at least.

Your eyes mostly and your ear mostly to your anaesthetist

on how the body and the heart

and the lungs are taking the stress of reperfusing.

And you have to have a plan B in your mind if things go horribly wrong.

OK, bottom clamp is off.

The liver is reperfused.

Alex's new liver has been successfully reperfused,

but it will be many hours before the operation is completed

and the new kidney is also transplanted.

In west London, Michael still hasn't heard

if his five-year wait for a new kidney will soon be over.

-Hello?

-'Hi, is that Kin Yee?'

-Yes, it is.

-'Oh, hi, it's Corinna.'

Oh, hi, Corinna.

I'm just calling up with the results of your cross match.

Oh, fantastic. Hang on a second. Right. So tell me?

OK, so the first patient on the list, that was all negative.

-Michael all negative?

-Yes, the sample from today.

Wonderful, that's great, thanks very much, bye.

-Hello, how are you?

-I'm all right.

-I've got very good news.

-Yes?

It's fine, so the result of the cross match was negative,

which means that this kidney, hopefully, if we put it into you,

will not be rejected.

I'll get the surgeons and let them know that we're sorting you out,

and we'll probably take you down to theatre in about 15 minutes.

That's good news!

OK, so it will be that quickly. OK?

Yes, very good, very good.

At Kings, Alex's combined liver and kidney transplant

has nearly finished.

Well, this is the liver, nice and pink and red, OK?

The kidney is down inside there and it also looks nice and pink.

It may have been a successful transplant,

but Daryl has been in this position before.

My worry all the way through has been Alex's intolerance

to some of the anti-rejection drugs.

So if he has that intolerance again,

there's no way back, as far as I can see.

Because of the trauma of the operation,

Alex will be kept sedated overnight.

It's strange, because even though he doesn't know

that I'm touching his hand, it makes me feel good.

Michael's kidney transplant will be performed

by renal transplant specialist Vassilios Papalois.

It will last four hours and, unlike most transplants, no organs will be removed.

There is enough room for the existing kidneys to remain in the body.

The patient's kidneys stay in

because they just don't function, they don't cause any problem.

Very rarely, we remove the patient's kidneys.

Get the new kidney out.

45 minutes into the operation,

Vassilios is almost ready to transplant the new kidney.

It's been kept chilled and in preservation fluid for 11 hours.

Well, first of all, you see the kidney is pale and grey.

All the blood has been flushed out of it

and has been replaced with preservation solution.

This is the urethra, the pipe that drains the urine

produced by the kidney to the bladder.

This is the artery here that give blood to the kidney.

It looks in good condition, it's well flushed.

Let's get prepared for reperfusion. More irrigation, please.

You need to make sure that all the small vessels in the kidney

will open up and start feeding with blood,

every single little bit of the kidney.

But because the kidney was on ice,

sometimes these vessels are in spasm. You need to break this spasm,

and the way to do it is to put warm irrigation around the kidney,

warm water around the kidney to allow for the spasm to break.

Once the new kidney is connected to Michael's system,

it fills with his blood.

So blood flow goes into the kidney and it looks nice and comfortable.

You see now the difference in the colour?

The kidney was grey and pale, and now it's nice and pink.

And despite the fact that it comes from an elderly donor -

relatively speaking, 65 years old -

it doesn't look too bad. Looks very good actually.

There and then, you change somebody's life forever,

and it happens in front of your eyes.

You are part of it, which is irreplaceable.

I don't think there is any other surgical specialty

that offers you this joy. A lot of stress, but a lot of joy as well.

Are you feeling all right?

That's good, you comfortable?

Within an hour of the transplant finishing, Michael is awake.

How's your tummy, Michael?

-All right.

-All right?

-Yeah.

Everything went very well. OK?

The transplant went very, very well.

Michael is awake and alert and communicating well,

so he tolerated the operation pretty well.

The transplant was very successful, he's already making some urine.

It's early days, but it looks very promising.

Very, very promising. Very pleased.

Within days, Michael is out of bed

and can reflect on the change in his life.

At one time, I said, "No, a foreign body within your body,

"it's not right," but I'm grateful for it.

Yes... Yeah, very grateful.

The transplant centre that received Penny's heart is 100 miles away.

At Birmingham's Queen Elizabeth Hospital,

the heart recipient is recovering from the transplant operation.

Until a few weeks ago,

16-year-old Zoe had no idea she had a heart problem.

It was a bit scary.

It was sort of like asthma, like shortness of breath

and then they gave me inhalers,

but they didn't seem to work.

So I went back with like...sickness

and worse breathlessness.

And then they sent me for an X-ray.

I remember getting the phone call off the doctor

to say that you need to get her up to A&E as quickly as you can,

they need to investigate, she'd got fluid on her heart and lungs.

They tried to get a blood pressure five times and couldn't get it,

so they rushed me to ITU

and, from there, they brought me to here

and that's all I remember.

Just pulling up there, and...that's it.

It was found that her heart function was extraordinarily weak,

her heart was grossly enlarged, each chamber was failing.

It was a very rapid deterioration in her condition,

that took her right to the edge of life.

Within 24 hours of Zoe being on the urgent transplant list,

Penny's heart became available.

Many hearts that we go to in respect of older donors

will have developed coronary artery disease.

And it could have happened in Zoe's case

where we would have to say, "No, it's not safe to proceed.

In Zoe's case, if that had happened, she wouldn't be here today.

One minute you've got an active and normal child,

and then the next minute, a heart transplant.

You hear of it happening to other people

but you certainly don't expect it to happen to yourself.

One minutes she's fine, the next minute she needs a heart transplant.

-It's frightening.

-You just kept thinking you'd wake up.

< Nightmare. We did.

I lost my mum at 38 of heart disease

and, um, she's buried locally, and I'd even thought

that Zoe would go in with my mum

and she would wear her prom dress. It was just...

But luckily...

I hadn't spoke to anybody about that, but that's what I was thinking.

I'd planned it, the funeral and the songs we were going to sing, and...

But, um, we haven't had to... Thank God, so... Sorry.

And hold your breath in.

Breathe normally.

Excellent, well done.

She has exchanged a desperate situation

which was going to end her life

with a transplant which requires constant medication and constant surveillance.

Thanks to somebody, she's able

-to take tablets to be healthy, haven't you, hm?

-Yep.

It's not unusual for young recipients

to receive hearts from older donors

and, in Zoe's case, her donor was nearly 50 years older than her.

If there was no problem with donor supply,

clearly, you would select a young, very healthy donor

with minimal risk factors for every transplant. It's just not possible.

When she's back home and she's better,

then we'll be able to start thinking about

who actually gave us the heart and, how will we ever repay them?

Following Penny's funeral,

her family, like all families that have donated,

receive a letter telling them about the people who have benefited from Penny's donation.

-Want me to read it out?

-Yes.

-OK.

"Dear Cyril, as I write to you...

"I realise that it's only been a short time since Penny died.

"I know that you and Emma must miss her very much. I am so sorry for your loss.

"You know I spent only a short time with you.

"I could tell by listening to you

"just how special a person Penelope was to you both,

"but I hope that you will find some comfort

"in knowing how your gift has helped so many people."

It's Penny's gift.

"I am pleased to inform you that

"a 16-year-old girl received an urgent, life-saving heart transplant.

"This young girl was exceptionally ill prior to her transplant operation

"and was being cared for on the Intensive Care Unit.

"I can only imagine the relief

"the parents, brothers and sisters will be feeling

-"as a result of her steady progress to recovery."

-She's so young.

A 16-year-old, a young child, I mean...she's got a life.

It's just amazing.

"I am also pleased to tell you that a 52-year-old gentleman

"has received a life-saving liver and kidney transplant.

"He is making steady progress and, since his transplant,

"he's not needed kidney dialysis.

"I understand he is very grateful

"for this chance to have a better quality of life.

"Another man aged 66 has also received a kidney transplant..."

I'm not doing well, am I?

"Thanks to your kindness, these two patients and their families

"can continue to live their lives

"free of the constraints that kidney dialysis can bring."

Wow.

It kept thanking us, it's not us.

So imagine that they've suddenly been called in,

they've got a match, and their life has changed overnight.

-You know, it's just incredible.

-Just amazing.

After his combined liver and kidney transplant,

Alex is up and he's beginning the slow process of recovery.

-And the right leg to start with now?

-Go with your good leg now.

-Yeah.

Sprint at the end.

It will be easier, it will be easier, every day, the better you are.

I did more than I thought I'd be able to.

So, obviously, each day, my body's recovering more and more

and I'm getting more energy and strength.

It was good.

You passed your exam.

Although the new liver and kidney have been successfully implanted,

Alex feels the responsibility of having a second transplant.

I felt with the first kidney

that I had to do everything to give it a chance to work.

Yeah. When things start to go wrong, you carry... You do carry guilt

because, at the end of the day,

someone's died to give you that chance,

and you feel an affinity with that family

and you really want it to work

because you want to make something positive come out of their grief.

And we're very hopeful that, this time, we'll be OK.

I feel like I will be able to get back to

as near a normal life as I had before.

Now I feel...

..just... there's things that I can do again.

Transplantation is not a sprint.

As with everything else in medicine, it's not magic

and you need a very proper and very tight follow-up.

It's something that's going on for years and requires proper monitoring

to ensure things are going well in the long run.

Michael has spent a month in hospital

and is well enough to be discharged.

Like everyone who's had an organ transplant,

he will need to take a combination of drugs for the rest of his life.

I would first of all start with the most important medication -

the immunosuppressant.

-That's right, yeah.

-Yeah?

-Yeah.

Those ones you have no excuse whatsoever to miss them

because they prevent your kidneys from rejecting, yeah?

The natural reaction of our body

when something new and foreign is introduced is to fight against it.

For example, if you get an infection from a virus or something, or a bug,

your immune system, your defence mechanisms tries to fight it.

When you do a transplant, your immune system doesn't know that this is for the good of the patient,

they see the kidney as a foreign body and attack it, OK?

If you don't treat this, if you are not prepared to treat this, it will destroy it, it will reject it.

So these ones, you take them four times.

-Four times a day, yes.

-And you take...

Immunosuppressants knock down your defence mechanisms.

The good news is, of course, that you don't reject your kidney.

On the other hand,

it makes you more susceptible to infection for example or cancer.

5ml. And one drop is 1ml.

-Right.

-Yeah?

You have to get the balance right

to get the benefit of preventing rejection,

but none of the side affects.

And you have one gram, which is two tablets, four times a day.

-Four times a day.

-Four times, yes.

I'll have to learn to get used to it!

-You are going home?

-Yes, thank you very much.

-Congratulations.

Even with medication,

15% of organ recipients will suffer some rejection in the first year.

Right, bye-bye.

Since the transplant six weeks ago,

Zoe has only been allowed home for a few days,

and she's being closely monitored.

Transplantation has its dangers,

it has its hazards at every step of the way,

and we try to steer them through that.

-Nice to see you.

-Hiya.

-Please have a seat.

This is the new heart which is working nicely for you,

and that's why you're feeling better and you are able to do

much more than what you were able to do before transplant.

Your heart is working well, OK.

But Zoe has been showing signs that she's rejecting the new heart

and has been given stronger immunosuppressants.

I know I shouldn't look on the dark side,

but if she was to reject today,

would she have to come back into hospital?

If today's biopsy does show there is still some residual rejection,

then we will have to admit you again

and give you a bit more stronger immunosuppression.

Right, OK.

And with that, you will have to be in hospital for at least seven days.

I don't want to scare you, OK?

In 95% of the patients, last week's treatment would have done the job.

Later that day,

the test results mean that Zoe IS readmitted for further treatment.

She's all right, she's a bit fed up,

but she's all right.

Because she's well in herself, so it's difficult,

it's hard for her to get her head around it, in't it? So... Yeah.

All right, Nan, bye. Bye-bye.

I mean we realise now, like,

we're going to be backwards and forwards for a long time.

But like when we left here the first time, a couple of weeks ago,

we just thought it was all over type of thing.

I did think that it was going to be a cure and it's shocked me...

it is really frightening, really.

Hopefully, we're having all these downsides to begin with

and then we can move on.

So we can get home again.

Yeah, I just want to go back home.

I feel fine, so I want to get back to normal.

It's been six weeks since Penny's death.

Emma and her fiance Matt

are spending as much time as possible with her dad, Cyril.

I think he's doing OK. Well, I say OK. What I mean is

we're getting out of bed, we're having a shower, we're eating, we're talking to people,

we're leaving the house, and that's as OK as you can be really.

I'm constantly thinking about her,

and it hurts in a way because your brain just doesn't stop.

Penny and myself, we always had this view that the surviving spouse

has got to get on with their life.

She would be living life to the full.

I haven't quite got there yet, but it's not far away, um...

Yes, we've got to get on.

Just a bit more, right, I'm just going to get...

For Penny's family, the donation of her organs has been a positive experience.

We don't feel any different because she donated her organs.

For us, it makes no difference, she didn't... As Dad said,

they're on loan to her and now they've passed on to someone else.

I suppose we weren't particularly precious over...

what she had with her when she was cremated.

We don't have memories of her heart or her liver or her kidney.

We have memories of her.

We've, in a way, lost a part of the future,

but they've got themselves a future which they didn't expect to have.

So whilst I feel slightly cheated, I feel this big plus side as well.

Today, Zoe and her family will get the results of her latest tests

to see if she's still rejecting her new heart.

So what do you want to hear?

So you had your biopsy today

and, congratulations, there's no rejection.

Oh, God almighty, thank God for that!

Brilliant. Go home, thank God for that.

I'm going home to see my friends and get back to normal, hopefully!

Bye! See you, bye, ta-ra.

-Bye, see you.

-Hope you won't see us for a long time!

No, thank you, see you!

'No-one knows whether she's going to live healthy'

or whether she's going to reject again.

That's what it is, not knowing.

So you've just got to let her live, do what she wants to do.

Is it nice to be back home, Zo?

-Yep.

-Your own bed.

-Yeah!

If it hadn't have been for the heart donation...

I don't know whether she'd be here now. I don't know.

-We're one of the lucky ones, aren't we?

-Yeah.

-We are.

At least we've got Zo now, haven't we?

Day-to-day existence has changed dramatically for Michael.

Despite several spells back in hospital, his new kidney

has given him freedom following seven years of dialysis.

I've got half my life back, you could say.

Apart from the two days I've got to go to clinic to see the doctors,

the rest of the time is your own.

I wouldn't be sitting here now playing dominoes.

It's an exciting time for me. Free, free as a bird.

Since having his combined liver and kidney transplants,

Alex has been in and out of hospital,

but the anti-rejection drugs are working.

The difference in him now to what he was pre-transplant

is absolutely unbelievable.

Not just in appearance - there's a physical appearance -

but it's also enthusiasm.

Yeah, you're just more alert.

-Yep. I'm getting more out of life basically.

-Yeah.

Rather than sort of like being in a daze for 24 hours a day.

I feel as if I've woken up.

-How fast do you want to walk?

-Not too fast!

Although they are moving forward, they will never forget the donation.

On behalf of their loved one, they've made a donation,

Alex has benefited. Just so thankful

that there are people that will do that. I just wish there were more

because so many people that I've met over this experience

who aren't going to survive because there aren't the organs for them.

And it's so heartbreaking.

I believe that people remain reluctant to reflect upon

what might happen to them at their death

and, therefore, there is a reluctance to discuss

whether you could donate at that time.

I strongly believe and advocate that we should make transplantation

and organ donation part of people's culture.

When people know about it, they will not say no.

In an ideal world, as I would like to dream, we shouldn't have

transplant coordinators approaching the families.

The families should approach the doctor and say, "We want to donate".

For us it was made easy, we discussed it.

But if we hadn't, I don't know how I would have felt in that situation.

We look at the fact that somewhere, she is saying,

"Good on you, you've done what I wanted."

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