One of the most precious developments of modern medicine, lifesaving organ transplantation enables over 4,000 people per year in the UK to have the ‘gift of life’ [1]. The Transplant Games were initiated by Maurice Slapak in 1978, principally as a vehicle to encourage transplantees to engage in sport and exercise. Indeed, physical activity, which includes sport, is reported to be the “the best buy for public health” [2] and intensive exercise and sporting activities being reported to have potential benefit for transplantees [3]. Promoting a healthy lifestyle which includes sport is important after transplantation as this has the potential to improve outcomes for transplantees [4].

Although research is available regarding both surgical management of organ transplantation and the post-operative management there are comparatively few quality reports considering the effects of high quality sporting activities on the cardio-vascular system and immune function of transplantees [3]. This is not surprising considering the speed of developments in successes in organ transplantation and the relatively few, yet rapidly increasing number who are performing sport at an international high level. Consequently, our understanding of the transplant athlete per se within the sporting environment has not yet paralleled the growth and success of national and international Transplant Games. Having worked with transplant athletes for nearly 10 years, personal observations on the participants at both the British and World Transplant Games has unearthed a number of very different transplantee backgrounds, experiences and journeys; all of which might be helpful to consider for those in the management of this population when supporting their sporting activities. Transplantees compete at high levels in all ages therefore consideration of the individual’s self should be considered.

1. Children with early age transplant.

Children may have been unwell since birth with resultant poor developmental or maturational milestones, such as in heart & liver transplants [5]. Equally, children may have had normal development but become ill for a short period of time and receive a living donor transplant, such as in kidney and liver transplants. These children receive life-saving transplants with little or no subsequent memory of any other lifestyle.  Here, parents naturally take lead responsibility for their care including medication. In such cases, the family reactions to these life threatening problems may influence behaviour and development more than healthy children [6]. Their exposure to physical activity may well also be understandably cautious.

2. Children reaching adulthood prior to transplant.

Children who grow up with inherited conditions, like cystic fibrosis, may well reach adulthood. In these instances school attendance may be difficult with the lifestyle being driven by regular physiotherapy, medication and an atypical childhood. This group are more likely to be given a lung transplant in their early adult lives to potentially have a ‘normal’ life, which, until this point, they have not experienced. These patients are in contrast to those receiving a transplant at a young age and, as adults, know no different lifestyle. Frequent visits to hospital and daily medication to maintain a healthy lifestyle remains their norm. There are now many young adults in this category who, through personal observation, demonstrate a range of reactions to their situation and life’s challenges. These young adults are usually exceptionally grateful to their parents for supporting them and remain close to family, however, tension can begin to appear as they become more independent and support to manage these changes is suggested [7].

3. Adults with sudden onset of illness

Adults also appear to fall into two categories. Firstly, adults that are perfectly fit and well but suddenly become seriously ill (e.g. acute hepatic failure, cardiomyopathy, acute liver failure). These patients receive their transplant either immediately or within a very short time span with little time being physically unwell. Their experience of life prior to transplant is thus essentially unaffected and if active before are often likely keen to return to active lifestyles.

4. Adults with acquired chronic illness

In contrast, there are patients whose health deteriorates slowly as a result of an underlying condition through acquired disease. Such patients may spend years on dialysis (e.g. cirrhosis and chronic kidney disease) with a slowly worsening conditioning whilst awaiting a suitable donor. These recipients have experienced normal life but also a slowly deteriorating condition. If previously active, they may not have been active since the condition developed or manifested itself. Their experiences of sport are likely similar to the average population but distorted by the development of a life threatening condition.

One commonality that all the above groups share is the grateful thanks for the organ they have received and their continued appreciation of the ‘gift of life’ which is truly awe inspiring.  We urge practitioners working in the sporting environment with transplantees to consider these factors within their professional practice when working with transplantees. Being understanding and empathetic of the journey and life experiences of transplantees will enable improved support for sporting lifestyles to maximise longevity of the donated organ.

References

1 NHS Blood and Transplant  https://www.organdonation.nhs.uk/ accessed September 2017

2 MacAuley, D., Bauman, A. & Frémont, P., Exercise: not a miracle cure, just good medicine Br J Sports Med. 2016: 50(18)1107-1108.

3 Neale, J., Smith, A.C. and Bishop, N.C., Effects of Exercise and Sport in Solid Organ Transplant Recipients: A Review. American journal of physical medicine & rehabilitation, 2017: 96(4), pp.273-288.

4 Mathur, S., Janaudis‐Ferreira, T., Wickerson, L., Singer, L.G., Patcai, J., Rozenberg, D., Blydt‐Hansen, T., Hartmann, E.L., Haykowsky, M., Helm, D. and High, K. Meeting report: consensus recommendations for a research agenda in exercise in solid organ transplantation. American Journal of Transplantation. 2014: 14(10), pp.2235-2245.

5 Organdonor.gov https://organdonor.gov/about/donors/child-infant.html Accessed September 2017

6 Supelana, C., Annunziato, R.A., Kaplan, D., Helcer, J., Stuber, M.L. and Shemesh, E. PTSD in solid organ transplant recipients: Current understanding and future implications. Pediatric transplantation. 2016: 20(1), pp.23-33.

7 David, V., Feldman, D., Danner-Boucher, I., Rhun, A.L., Guyomarch, B., Ravilly, S. and Marchand, C. Identifying the educational needs of lung transplant recipients with cystic fibrosis.Progress in Transplantation. 2015: 25(1), pp.18-25.