About Your Transplant

At Houston Methodist J.C. Walter Jr. Transplant Center, one of our goals is to communicate with you effectively in order to help you make the best decisions regarding transplantation. With that in mind, we offer you more detail about what to expect regarding the general transplant process and what issues you will need to address once you return home after your transplant. To learn more, click a topic below: 

The Transplant Journey
Your journey at the Houston Methodist J.C. Walter Jr. Transplant Center begins with a thorough evaluation performed by our caring experts. As a patient in the transplant program, the process begins with a detailed health evaluation to give us an accurate picture of the severity of your condition and your fitness for surgery. Tests will likely include the following assessments:

  • Blood tests to check for viruses and compatibility matching (if applicable)
  • Urine tests to check for disease, drugs and alcohol in your body
  • Tests to determine if you have any problems with your lungs
  • Examinations to understand the overall function of your heart (this may include electrocardiogram, echocardiogram and adenosine nuclear stress test)
  • Computerized tomography (CT) scan or ultrasound and vascular studies to see how much disease you have and determine the size and shape of your existing organs and blood vessels
  • Doppler studies to see if there are blockages in the vessels in your neck or legs
  • Colonoscopy to check for colon cancer inside the colon or rectum
  • Vaccinations, if your transplant doctor decides these are necessary


During your evaluation, you will also meet with a financial counselor to review insurance coverage and discuss the financial considerations associated with a transplant. A social worker will conduct an evaluation to ensure that you and your family are emotionally prepared for the stress that often accompanies the transplant process.

About the wait list
All patients accepted by a transplant program are put on a national computer wait list kept by the United Network for Organ Sharing (UNOS) to ensure that all patients in need of a transplant are given fair access to donor organs. This list does not apply for patients receiving a ventricular assist device implant or for those receiving bone marrow or islet transplants using their own cells or tissue.

Rules have been established to determine how transplant candidates are ranked on the waiting list for each type of organ. These rules, called allocation policies, were developed by patients and transplant professionals to ensure every patient on the waiting list has a fair and equal chance to receive the best organ at the best time for their specific condition. Organ allocation is different for each organ.

For more information on organ allocation, click here.

During the wait period

Once you are placed on the list, the wait for a donor organ begins. From the time you are placed on the list, you need to be ready to receive a transplant. You will be seen in the transplant clinic frequently for labs and follow-up visits with the transplant team. During the waiting period, you and your caregivers are also encouraged to attend our education classes on the transplant process.

It is critical that we always have your current address, phone number and insurance information. You should also have a primary care doctor for treating minor health issues. If your condition worsens while you are waiting for your transplant, or if you go to the hospital for any reason, please contact us immediately so our team is aware of the situation.

The transplant surgery
Before the transplant takes place, your anesthesiologist will talk with you and explain what will occur during the surgery.

You will be in the operating room for a number of hours determined by the type of transplant, the number of organs being transplanted and the individual characteristics of your transplant surgery.

The procedures for islet transplant and bone marrow transplant are non-surgical.

After transplant surgery
After surgery, you will be taken to the recovery room until you are awake and then you will be moved to a hospital room where you will be closely monitored until you are discharged. In some cases, a brief stay in the intensive care unit (ICU) may be needed.

We will help you manage any pain you may experience after surgery. Most patients find their pain decreases within a day or two. Getting out of bed and walking may help reduce pain.

You will remain in the hospital as long as your doctors feel it is necessary.

Going Home and Staying Healthy
After you leave the hospital, you will continue recovering at home. Your daily activities will be limited for a few weeks after surgery.

During recovery, we will continue to closely monitor your progress, so you must remain available for regular clinic visits, blood work and possible imaging scans. This will help us determine how well your transplant is working.

One year after your transplant the frequency of clinic visits will decrease. You will be required to come to clinic at least once a year to be monitored for long term complications associated with your transplant. Your physician will determine if you need to be seen more frequently.

Most transplant patients return to normal activities within a few months of the surgery, and you may not have many restrictions on your daily routine. You will need to continue to follow the advice of your transplant team so you are living the healthiest life you can; notify us immediately if your condition changes.

Back to top>>

Life After Transplant
Following your transplant surgery, your team will show you how to properly care for your incision, understand your medications, recognize the signs of infection and rejection and they will explain the lifestyles changes you will need to adopt. It is OK if you feel a bit overwhelmed by all this information; your transplant team is here to make this transition as easy as possible for you and your family or caregivers.

The following set of links will take you directly to the appropriate information on this page:


You may also scroll through and read the entire page.

Keeping Your Patient Diary
The first thing you will need to do to ensure a healthy and successful result after your transplant is to keep a diary so that your progress can be tracked while you recover at home. You can download the patient diary form here. The general things you will record include temperature, blood pressure, weight and possibly blood sugar.

Your coordinator will let you know what needs to be recorded and for how long. Please bring this diary with you to all clinic appointments for review.

  • Take your temperature if you feel chilled, have flu-like symptoms or show any sign of infection. If your temperature is higher than 101°F, call the transplant center immediately.
  • Check your blood pressure every morning and evening, especially if you are on blood pressure medications. Call the transplant center if you have two readings in a row that are elevated; your coordinator will explain what “elevated” means in your specific case. If you have an elevated or significantly decreased number, take your blood pressure in both arms and call the transplant center immediately. Your medication may need to be adjusted.
  • Weigh yourself every morning before breakfast. If you see a weight gain of five pounds or more in two days, call us immediately.
  • If you have diabetes or a problem with increased blood sugar, then you may need to check before each meal and at bedtime. The diabetes educator will give you instructions on how to do this before you return home.


Back to top>>

Caring for Yourself at Home
When you leave the hospital, you will be responsible for caring for yourself. This includes bathing, caring for your incision and managing peripheral pain and swelling which may not be directly related to the surgical site.

Bathing and Caring for your Incision. You may be going home with your incision staples in place ; if so, these will be removed in the clinic a few weeks following transplant surgery. 

  • If your incision is healing well, you may shower.
  • Do not take a bath in a tub until the staples are removed. Sitting in a bathtub may increase the risk of infection to your fresh wound.
  • Use the soap of your choice for cleaning.


After your staples are removed, Steristrips may be placed across the incision. You may continue to shower, but do not remove the Steristrips; they will fall off on their own in approximately five days.

If you have a drainage tube, it may remain in place after transplant. Your transplant team will educate you on how best to care for this. If you notice that the stitches around the tube become loose, notify your transplant team immediately. 

Managing Peripheral Pain and Swelling
The best treatment for peripheral pain and swelling is to avoid lying down for long periods of time. Walking will also help.

You may have leg swelling prior to and after your transplant. This should go away in time as your new organ increases its function. It is best to keep legs elevated while sitting and to avoid standing still. A low-salt diet and regular walking will also help reduce swelling. Do not take any diuretics that were given to you prior to transplant unless prescribed by the transplant team.

Back to top>>

Managing Your Medications and Side Effects
After surgery, you most likely will need to take medications to prevent rejection and infection. Before you are discharged, you will receive a 30-day supply of your transplant medications to take home.

You will also receive a pill box and a medication schedule with the dosages and instructions for each of your medications. Always use a pencil to write in the schedule and keep it up to date. Be sure to bring your medication schedule with you to all of your doctor appointments. 

Medications Related to your Transplant
If you accidentally miss a dose of a transplant medication, take it as soon as you remember. However, if it is almost time to take the next dose, skip the missed dose and resume your regular schedule. Keep in mind that missing even a few doses can lead to rejection.

  • Immunosuppressant (anti-rejection) medications are taken to prevent your immune system from rejecting the transplanted organ. It is important to take these medications exactly as prescribed for the rest of your life. Failure to take these medications can result in your immune system rejecting the transplanted organ; taking too much can result in serious adverse effects, including various infections.
  • Because your immune system is suppressed after surgery, your body’s ability to protect itself against infection is lowered. This means you are more susceptible to certain types of infection. For the first few months after your surgery, you will be required to take medications to prevent infections.


We will give you five refills on all your transplant medications. You have the option of returning to your regular community pharmacy or staying with the home-delivery pharmacy to order your first month’s supply. When you are running low on any medications, call your pharmacy at least five days in advance to request a refill. If you are out of refills, you should have your pharmacy fax a refill request to the transplant center. If you are eligible for a 3-month supply of medications, make sure you have at least a 2-week supply remaining before setting up this process.

Prescription Medications Not Related to your Transplant 
Some of the medications you were taking prior to transplant will be discontinued. Blood pressure, cholesterol and other medications may be continued. We will instruct you on which medications you should stop taking.

If you see other physicians (for example, primary care, cardiologist, infectious disease or other) who change your prescriptions, tell your transplant team right away. 

Over-the-counter Medications
Some over-the-counter (OTC) drugs can interact with your transplant medications and some can even harm your transplanted organ, so do not take any medications other than those prescribed by your transplant team without discussing first with your doctor or transplant coordinator.

This includes nutritional and herbal supplements as well as OTC medications. You should avoid three types of OTC medicines after your transplant.

  • Cold medications or decongestants containing pseudo-ephedrine (such as NyQuil or one having a “D” in the name like Tavist-D or Claritin-D) can cause or worsen high blood pressure.
  • Herbal supplements are not FDA approved and may cause a range of damage to your transplanted organ.
  • Diet pills are not FDA approved and many lead to harmful side effects.


In addition, NSAIDs such as ibuprofen (Advil™ or Motrin™) and naproxen (Aleve™) should be avoided.

Four Rules for Transplant Medication Safety
You should keep four rules in mind to stay safe with medications after your transplant.

  • Do not take any medications other than those prescribed to you by your transplant team without discussing it with them first.
  • Never stop taking any of your medications without notifying the transplant team. If you are experiencing side effects, discuss these with your transplant team.
  • Always follow the most recent instructions when taking your medications.
  • Notify the transplant team if you notice a difference in your anti-rejection pills. Generics are often fine, but the transplant team needs to know if the pharmacy is providing you with these.


Back to top>>

Getting Active Again
When you return home following transplant, you may have to make a few changes in some of your daily activities.

Exercise. Exercise is the best way to gain strength after surgery. Once you are discharged from the hospital, you may begin light exercise.

  • The best form of exercise after a transplant is walking. We recommend starting off at a slow pace and increasing your tolerance to 30 minutes a day.
  • Swimming is also good, but swim only in treated pools. Public pools, lakes or rivers contain excessive bacteria.


Exercise should be a gradual process. If you experience any pain, shortness of breath, dizziness or irregular heartbeats during exercise, stop immediately.
You need time to recover after your transplant. It is recommended that you not drive or lift anything heavier than 10 pounds until cleared by your physician. After surgery, your abdominal muscles are weak. If you overexert them, you can cause a hernia.

Weightlifting, sit-ups and pushups are restricted for the first three months after transplant. Ask your transplant team before beginning any new exercise program.

. You should not drive for at least one month after transplant. This is to protect your new organ from injury should you have an automobile accident and the steering wheel hit you near the wound. Your vision and depth perceptions may also be impaired during this time due to higher doses of anti-rejection medication.

If you ride in a vehicle, always wear a seatbelt; it will not hurt your new organ. If your wound is partially healed, you may place a small towel or pillow under the seatbelt for added protection.

Work. You may return to work or school when you feel that you are ready and you have been cleared to do so by the transplant team. Remember that you will have regular ongoing appointments and lab tests, so you will have work them into your new schedule.

Sexual Activity. You may resume sexual activity when you and your partner are ready. Condoms are vital to prevent the spread of diseases.

Birth control is recommended for all transplant patients. You should wait at least one year after transplant before considering pregnancy or fathering a child. Childbirth while taking immunosuppressant medications is associated with an increased risk of birth defects. If you are considering pregnancy or become pregnant, discuss this with your transplant team so that your medications can be adjusted if necessary. We recommend that all women use a condom, diaphragm or spermicides, but not IUDs since there is an increased risk of infection with these. Check with your transplant team before considering birth control pills.

Women who have not had menstrual cycles during their disease should see them return within a few months after transplant. Ovulation can resume even before the cycles begin. This is why it is important to use birth control and discuss concerns about childbearing with your transplant team.
Some conditions may cause men to become impotent. After transplant, sexual function normally returns, but some posttransplant medications can prolong periods of impotency.

Traveling. We advise you to not do any extensive traveling during the first six months after transplant, and traveling to developing countries is not recommended due to the risk of exposure to serious infections.

When you travel, remember to keep your medications with you and never place them in a bag that needs to be checked at a terminal. This will prevent you from ever being out of medicine in case your luggage does not make it to your destination.

Consider wearing a medical alert bracelet whether you are traveling or at home. This will help other physicians know your general health status in case of an emergency.

Sun Exposure. Because you may be taking immunosuppressive medications, you are at an increased risk for developing certain cancers, particularly skin cancer. You should follow a list of suggestions to decrease your exposure to the sun.

  • You must wear sunblock with SPF 30 or greater
  • Wear protective clothing, including hats and long sleeves.
  • Limit your time in the sun.
  • Avoid being in the sun between 10 a.m. and 2 p.m.
  • Never use artificial tanning beds, tanning lotions or tanning lamps.
  • Examne your skin regularly and report any changes to moles or lesions.
  • Have your skin examined by a health professional once a year.


Back to top>>

Eating Healthy
Maintaining a healthy diet is essential to preventing complications after your transplant. After meeting with the dietitian, you will be sent home with instructions designed specifically for your dietary needs. Before you leave, you will have time to ask the dietitian any questions about your diet and how to maintain an ideal body weight.

We offer some instructions on how you can make the most of nutrition to ensure you do not endanger your new organ.
General Concerns. We recommend a diet low in fat, cholesterol and sodium.

Weight gain is a common problem after transplant, and is usually caused by prednisone (an immunosuppressant) which can increase your appetite and make you retain water.

You do not need to buy bottled water. You may drink your regular water unless you use water from a well. If you have well water, you will need to boil it before drinking to rid it of any contaminants.

In addition to water, you may also drink juice, tea, coffee and soda. If you use a well and make your own tea, make it by boiling the water first.

Dietary Guidelines to Prevent Infection. You should follow this set of guidelines to keep the chance of posttransplant infection low.

  • Stay away from raw seafood, including sushi and raw oysters.
  • You should not consume raw eggs.
  • All meats you eat should be cooked to well done.
  • Do not drink grapefruit juice because it may interact with your anti-rejection medication.
  • The fruits and vegetables you eat should be washed thoroughly.
  • You may cook with salt, but do not salt your food at the table.
  • Do not use salt substitutes because they contain a high amount of potassium.
  • Alcohol and non-alcoholic beer should not be consumed unless you have discussed with your physician.
  • Do not smoke; that includes the use of marijuana and chewing tobacco.

Safe Food-handling Techniques
. Remember to follow all safe food-handling techniques.

  • Store food promptly and appropriately.
  • Wash your hands thoroughly after handling raw poultry, fish or meats. You may consider using disposable latex gloves to perform any task where you come in contact with these foods.
  • Eat leftovers within one to two days (freeze any extra portions).
  • Be aware that buffets, salad bars and potlucks — any situation where food sits out too long — may be a source of food contamination.
  • Drink from safe water supplies.


Back to top of section>>

Watching for Signs of Infection
If you are taking anti-rejection medications to protect your new organ, these drugs will also make your immune system weak. This puts you at a relatively greater risk for developing infections such as colds and the flu. Even simple infections can be serious to a transplant patient.

As your anti-rejection medications are decreased, you will be better able to fight off infections, but remember: You may be taking anti-rejection medications for the rest of your life, so you must be very careful to avoid potential infections.

If you stop or decrease your anti-rejection medication, your new organ may be rejected quickly.

Signs of Infection. Be vigilant in your watch for signs of infection:

  • Fever of more than 101°F
  • Redness, pain or drainage at your incision
  • Sore or scratchy throat
  • Cough or shortness of breath
  • Flu-like symptoms such as chills, aches, pains, headache, fatigue, nausea and vomiting
  • Diarrhea
  • Burning, painful or frequent urination


You will be taking medications that suppress your immune system after transplant which make you prone to many infections. Your transplant team will teach your how to minimize and recognize these infections.

Sources of Infection. Sources of infection to be aware of include pets, vaccines and viruses, gardening and dental work.

  • Dogs and cats are appropriate to have in your home as long as they have been evaluated by your veterinarian to be sure they are free of disease. Do not clean up after your pets; someone else in the home will have to take on this responsibility. If your pets are on medications, it is probably prudent that you do not handle these drugs. You should not have birds and reptiles because they can pass along infections to humans.
  • You cannot receive any vaccines containing live viruses. Vaccines with live viruses include chickenpox, smallpox, measles-mumps-rubella (MMR) and oral polio. You should also avoid children who have received live vaccines. One year after your transplant, you will be eligible to receive flu shots and the Pneumovax® vaccine for pneumococcal pneumonia.
  • Avoid gardening for the first year after transplant. After a year has passed, you must wear gloves and a mask to protect against molds and fungus. Wash your hands thoroughly after gardening.
  • You should brush and floss every day to protect from gum disease that can lead to infection. Do not have any dental work done for the first few months after your transplant. After this time, it is important to resume regular dental appointments because some of the immunosuppressive medications can affect your gums. Let your dentist know that you have had a transplant. Routine cleaning and major dental work requires oral antibiotics to prevent infection. Notify the transplant team if you are to have dental work so that you can receive the proper antibiotics.

Reducing the Chance of Infection. You can decrease your risk of infection in a number of ways:

  • Wash your hands often.
  • Avoid crowds.
  • Avoid people who may be sick.
  • Do not walk barefoot.
  • Avoid raw or undercooked meats.
  • Avoid raw or undercooked seafood, including sushi and raw oysters.


Back to top of section>>

Watching for Signs of Rejection
Most transplant recipients experience at least one episode of organ rejection. This does not mean you will lose your new organ; rejection is almost always reversible if caught in time. It is natural for your immune system to see your new organ as a foreign object and try to attack it. To help your body accept your new organ, we give you immunosuppressive medications. To keep your body from rejecting the new organ, these medications must weaken your immune system.

You should always take your anti-rejection medications as directed and report any changes in your health as soon as possible. Early detection and prevention are essential to reversing the process of rejection, which can occur at any time. There are several signs which may signal possible organ rejection:

  • Flu-like symptoms such as chills, aches, pains, headache, fatigue, nausea and vomiting
  • Fever over 101°F
  • Cola- or tea-colored urine
  • Clay-colored stools
  • Pain or fullness over your incision site
  • Not feeling well in general


There are cases where you may experience rejection without having any symptoms at all. That is why it is important to keep your follow-up appointments – the blood tests taken during these appointments may reveal the first signs of rejection.
To find out if your organ is being rejected, we may ask that you repeat your lab tests and have an ultrasound or biopsy. If the tests detect rejection, you will probably be admitted to the hospital for treatment.
Most rejection is reversible if it is found early, so it is critical that you report any signs of rejection to your transplant team as soon as possible.

Back to top of section>>

Calling Your Transplant Coordinator
You should call your transplant coordinator any time you see signs of complications:

  • Any sign of infection
  • Temperature over 101°F
  • Diarrhea
  • Redness, swelling or drainage around your incision
  • Nausea or vomiting
  • Dizziness
  • Changes in blood pressure
  • Persistent coughing
  • Easy bruising
  • Changes occurring with a new medication prescribed by another physician
  • Missed doses of medication
  • Any hospitalization outside of your transplant center
  • Any care from another physician


If you call to report illness, you will need to have certain information available:

  • Temperature
  • Weight
  • Blood sugar level, if applicable
  • Blood pressure and pulse
  • List of current medications
  • Name and phone number of pharmacy


If it is an emergency and you can’t reach your coordinator, you can call 713.441.5451 . Ask the answering service to connect you to the transplant coordinator on call. If it is not an emergency, please wait until regular business hours to call – Monday through Friday, 8 a.m. to 5 p.m.

Back to top of section>>

Thanking Your Donor

Many transplant recipients choose to write a letter of thanks to the donor family for the gift of life they received. These letters are anonymous; neither the donor family nor the recipient is identified by name. You decide when the time is right for you to send the letter.
Donor families usually appreciate a simple letter of thanks because they like to know how the transplant has impacted your life. In the letter, you may include your first name, occupation, marital status, hobbies, condolences to the donor family (if the donor is deceased) and an account of how the transplant has affected your life. You may not include your last name, the date of the transplant, where the transplant took place or the physician who performed it.
Occasionally, donor families may choose to respond to your letter. All letters remain confidential and are mediated by the local organ procurement bank.
If you need help writing this letter, someone at the local organ procurement bank can help.
Once you have written your card or letter, place it in an unsealed envelope. On a separate piece of paper, write your name, date of transplant and the organ you received. Place all these items into a second envelope and mail it to your transplant coordinator.

Back to top of section>>

Back to top