Having an organ transplant is a monumental event. For the recipient, receiving “the gift of life” inevitably involves making important life changes to optimize health post-transplant. Some of these adjustments involve lifestyle changes, such as avoiding crowded spaces unless wearing a safety mask, not swimming in rivers or lakes to avoid potential waterborne bacteria, and taking extra precautions in regards to sun exposure since some medication can increase photosensitivity. Other changes involve a shift in diet and approach to food preparation. Knowing what’s safe to eat and what is best avoided is critical in keeping organ recipients healthy and protected.
The High Risk Group
While food safety is important for all, it is of the utmost importance for individuals post-transplant. After transplantation, organ recipients are permanently placed on immunosuppressants, medications designed to reduce the risk of rejection. While these anti-rejection meds force the body to see the new, donated organ as viable, they do so by effectively short circuiting the body’s natural immune system. This makes the organ recipient far more vulnerable than the average individual to contracting all kinds of infections, including foodborne illnesses. According to a pamphlet by the USDA, “Immunosuppressive medications are important, as they can protect your transplanted solid organ and/or bone marrow. But a side effect of these immunosuppressants is that they leave you more susceptible to developing infections— like those that can be brought on by disease causing bacteria and other pathogens that cause foodborne illness.”
In the food safety space, we call individuals with this unique condition “the high risk group.” Because of this condition, transplant patients are more likely to have a lengthier illness, undergo hospitalization, or even die, should they contract a foodborne illness.
In order to best protect themselves, organ recipients must be aware of which food items carry greater risk of contamination by pathogens. Some foods, even common ones, are more risky than others. Individuals should also be well versed in safe food storage and preparation as well as how to make food safety decisions while grocery shopping or dining out. Hygiene rules such as proper hand washing are also imperative.
Health Agency Recommendations
As the FDA notes in the manual on this subject, organ recipients should be especially cautious in selecting fresh fruits and vegetables. Because they are uncooked, they carry increase risk of being contaminated with harmful bacteria or viruses. All vegetables should be washed, including lettuces and salad. A safer choice is cooked vegetables. Raw sprouts (alfalfa, bean, etc.) should be avoided. As the CDC has noted in their examination of food-borne illness over a decade long study, “leafy vegetables accounted for the most illnesses. Many of those illnesses (46%) were caused by norovirus.” Thoroughly washing vegetables or heating them to a temperature that will kill bacteria is advisable. Proper refrigeration of vegetables is also needed, as cooler temperatures slow the growth of harmful pathogens. The FDA advises transplant recipients: “Never thaw food at room temperature, such as on the countertop. It is safe to thaw food in the refrigerator, in cold water, or in the microwave. If you thaw food in cold water or in the microwave, you should cook it immediately.”
Raw seafood, such as sushi or raw oysters, should be avoided to minimize risk of exposure to pathogens, such as vibrio or campylobacter. Vibrio is especially concerning, as those in the high risk group are susceptible to developing a long term complication of the infection called necrosis fasciitis – which could lead to limb amputation or even death. Cold cuts, hot dogs or other deli style meat or poultry are also problematic as these food items may be left at temperature that inhibit potential growth of listeria. Soft cheeses made from unpasteurized milk such as brie, feta or camembert can also increase risk of exposure to listeria. Any kind of raw or unpasteurized dairy product or juice should be avoided, as the process of pasteurization eliminates the risk of contamination by E.coli, salmonella or other food borne pathogens.
Heat is Your Friend
Cooking food to the correct temperature is vital to ensure food safety. For this reason, organ recipients should avoid soft boiled or over easy eggs. Products that may contain raw eggs, such as cookie dough or Caesar dressing, should likewise be avoided. It is recommended by the FDA that transplant recipients use a thermometer when cooking to ensure food has reached a high enough temperature. The minimal safe internal temperature for food such as fish and steak is 145 degrees F. For items such as egg dishes, pork, turkey and duck, a temperature of 160 degrees F is required for guaranteed safety.
Other Food Safety Tips
When taking leftovers from restaurants, food should be properly refrigerated and consumed in a timely manner. Being a safe shopper and reading labels carefully is important. In addition to checking for pasteurization, transplant recipients should consult “sell by” and “best by” dates, should avoid bruised or damaged produce and should carefully examine all canned items for dents, cracks or bulging.
Just like all consumers, organ recipients should be sure to wash their hands thoroughly before and after handling food. Cross contamination can be avoided by washing plates and cutting boards with warm, soapy water. Soft drink can lids and food can lids should be wiped off before opening as cans are often stacked on top of each other in transportation and storage, increasing the likelihood that dirt and germs can be found at the top of the can.
Making safe food choices after transplantation is important to maintaining good health. Being aware of food temperatures, remaining vigilant about hand-washing and hygiene and avoiding food choices with elevated risk can all go a long way to keeping organ recipients safe. Be sure to consult with your doctor or health care provider as he or she can answer any specific questions or help you in your choices. And if you are unsure of a food item, it’s best to live by the adage, “when in doubt, throw it out.”
By: Kate Delany, Contributing Writer (Non-Lawyer)