The first woman in the United Kingdom to have all her major organs transplanted has now signed on to a lifetime of hospital visits -- but this time as the doctor.
Allison John, 32, made medical history in 2006 after she received her fourth organ transplant -- a kidney from her father, 61-year-old David John, to add to her previous heart, lung and liver transplants.
A life plagued by illness and frequent hospital visits has not deterred John from her dream of becoming a doctor, however. After 14 years of interrupted study, she finally received her medical degree from Cardiff University last month, according to the U.K. press.
John will begin rounds as a junior doctor at Neville Hall Hospital in Abergavenny, England.
Considering that her combined heart-lung transplant alone has only a 40 percent survival rate in the first five years, according to the United Network for Organ Sharing, John is extremely fortunate to have survived three separate transplant operations.
"At the moment, I feel I'm in the best shape physically that I've ever been and I'm so excited about the future," John told the U.K. press.
Why would one person need so many organ transplants?
Just weeks after her birth, John was diagnosed with cystic fibrosis, an incurable genetic condition that results in the formation of thick mucus that plugs up the tubes leading to the lungs and liver -- though other organs also can be affected by it.
"Cystic fibrosis can result in lung and liver damage, as the thick mucus causes inflammation and infection that destroys [organ] tissue," said Dr. David Cronin, associate professor of transplant surgery at the Medical College of Wisconsin.
According to the U.K. press, John's liver was transplanted first, at age 15, but just a year later, doctors told her she would also need a lung transplant and she received a combined heart/lung transplant less than a year later.
Given she already had undergone a liver transplant, it might sound strange that doctors would give John a lung and heart transplant once her lungs failed, but there are advantages to adding the heart into the mix, Cronin said.
"At the time that transplant was done, doing heart and lung transplants together was much safer and easier than doing an individual lung transplant," he said. "When you do both, you take the heart and lung out as one unit from the donor and put it into the recipient. Basically, you're doing a heart transplant and the lungs come along for the ride."
Also, the liver failure experienced by those with cystic fibrosis can put extra stress on the heart, so transplanting the heart, as well can be beneficial to survival, said Dr. Fredric Gordon, medical director of liver transplantation at the Lahey Clinic Medical Center in Massachusetts.
Would each successive transplant surgery be riskier than that last?
Not necessarily, Cronin said. While risk of infection would be there with each operation, the past transplants, once established, would not necessarily increase the risk of the next ones.
She also already would be on immunosuppressive drugs, so she wouldn't have to start those or increase the dosage for the subsequent surgeries, Gordon said.
Ironically, but not surprisingly, John's final organ transplant actually was a product of her first three. Organ recipients must be on a lifetime regimen of drugs to suppress their immune system in order to stave off the body's rejection of the new organ. The drugs however, have side effects that can slowly weaken the kidney.
"John had what 30 percent of liver transplant patients and 40 to 50 percent of heart transplant patients develop in the five years after transplant: kidney failure as a side effect of the immunosuppressive drugs," said Cronin.
Given that John will have to remain on immunosuppressant drugs for the rest of her life, her donor kidney may suffer the same fate as her original one because of the drugs, Gordon said.
It is a problem that transplant surgeons only have been able to detect in more recent years, as patients survive long enough to experience that particular side effect five, 10, 20 years down the road, Cronin said.
"[John] has done miraculous[ly]," Cronin said. "It's more than 10 years and it looks like she's full steam ahead."