Travel Tips

Traveling after transplant can be a very exciting endeavor, especially if you are feeling better than before; however, it requires a lot of planning and extra measures to make sure that you keep yourself safe and healthy now that you are immunosuppressed and more susceptible to infection. Also, when organ transplant patients get infections, the infections are more severe.

The risk of acquiring infections depends on many things: (1)

The region visited
The traveler’s age and general health
The length of the trip
The type of recreational activities
Prevention measures before travel

Generally, you will be required to stay in the area of your transplant center for 3-6 months post-transplant. After that, you usually are allowed to return to your respective hometown, pending you have no other major complications. The prospect of returning home is exciting and the idea of going other places is even more so. Here are some general tips to consider when traveling home or to other destinations:

Tell your transplant center when you are traveling and where you will be traveling to- if you are traveling to a foreign country you may be required to receive extra vaccinations (see our section on Travel Vaccinations for more information).

Always bring at least two weeks of extra medications with you- you never know when you may get stuck in a destination or if dosages may change when you are in your destination, so it is always best to bring extra medications with you in the chance this occurs.

Carry your medications in their original pill containers with the pharmacy label still attached.

Carry an up-to-date list of medications with you at all times.

Make a plan before you travel, locating the hospitals and physicians closest to where you will be staying in case the recipient needs medical care while traveling.

The American Embassy or consulate can also be contacted if you need help finding a hospital or physician in a foreign country.

Carry a medical ID and wear a medical alert bracelet while traveling.

Check if you will be crossing into different time zones. Ask your transplant team how to adjust dosing schedules of your medications if necessary.

High Risk Destinations include:

Africa, Asia, Central and South America, Middle East, Pacific Islands
Developing Countries
Tropical Regions

High Risk Activities Include:

Rural village home-stays, budget accommodation.
Eating or drinking from markets or roadside stands.
Caving, dirt biking, eco-adventure tourism, or excavating.

Air Travel:

Carry medications/supplies on the plane with you.

Do not check medications with your bags because they may be lost or exposed to extreme temperatures in the plane’s cargo area.

Bring a cooler bag with a freezer pack to keep refrigerated medications at a cool temperature and stow them in the seat in front of you on the airplane.

Request a letter from your transplant office with permission to travel with needed medications and medical supplies to make the airport security process easier

On the plane: Wipe down the seats, seatbelts, tray tables, and areas around you on the plane with disinfectant wipes.

Use hand sanitizer and/or wash your hands with soap and water often and always before and after you consume any food or beverage.

Eating and Drinking While Traveling:

Only drink bottled or canned drinks, unless it is a beverage like tea or coffee that is made with boiled water.

Avoid iced beverages if traveling in an area where there may be poor water quality. If there are no bottled or canned drinks available, you will need to boil water for cooking and drinking and allow it to cool before use.

Monitor the food the recipient eats and make sure it is well cooked.

Avoid rinsing your toothbrush with tap water.

In areas where sanitation is poor, avoid unpasteurized milk and other dairy products like cheese or fresh milk.

Fruit must be peeled or cooked. Do not eat raw fruits or vegetables in an area where water quality or sanitation are poor.

Swimming While Traveling:

Swimming in contaminated water increases risk for infections, especially ear or stomach infections if you submerge yourself in the water.

Different transplant centers will have different guidelines and recommendations for swimming, however, properly chlorinated pools are generally relatively safe to swim in as long as you do not submerge yourself in the water for prolonged periods of time and you rinse off before and after you swim.

Ponds and lakes are the riskiest areas to swim, due to stagnant water and build-up of bacteria and other infectious agents (parasites). Avoid these.

Oceans are relatively safe to swim in as the waves keep the water moving and thus there is not a build-up of bacteria and infectious organisms like a lake or pond. Ask your transplant team for their recommendation, but generally oceans are considered safe to swim in.

Do not swim if you have any open, unhealed wounds.

Try to avoid swallowing any water while swimming.

Other Travel Activities to Avoid:

Amusement Parks: You should consult your transplant team about amusement park rides that are acceptable to ride on if you are going to visit an amusement park or fair.

Many roller coasters and other rides are very rough and could potentially cause damage to your transplanted organs and are advised against for transplant patients.

In What Situations Should You Avoid Travel?

At this time, due to COVID-19, all transplant patients are advised not to travel to any destination as weakened immune systems puts all patients at increased risk of becoming infected with the virus and having severe disease and dismal outcomes.

Avoid travelling to higher risk destinations in the first year after receiving a new organ and during times of organ rejection that require an increase in anti-rejection medicines. This will be different for each individual and transplant center. You can check the CDC and website and your transplant center for guidance.

Locations where non-sterile needles or equipment may be used.

Areas where blood products are in limited supply if you may need a transfusion.

Malaria

Malaria is an infection caused by a bite from a mosquito infected with parasites. Infection can cause fever, chills, and muscle pain; more severe cases can result in organ damage or death. Your doctor can prescribe certain medications to help prevent malaria if you are traveling to an area in which it is a concern, but be aware that many anti-malaria medications will increase the blood levels of anti-rejection medications and could lead to toxic levels. Discuss the best medications with your transplant team before you leave.

Malaria Prevention Measures:

Use mosquito repellent with >50% DEET.
Use permethrin impregnated bednets.
Wear long sleeve, long leg, loose light clothing.
Avoid being outside when mosquitos are feeding.
Stay in accommodation with screened windows and doors.
Take appropriate malaria prevention medication.

Dengue Fever

Dengue is a virus that can cause an infection with high fever, rash, muscle, and joint pain; severe cases can cause serious bleeding and shock. There is no treatment or vaccine for this virus. It is recommended to avoid areas in which this virus is common.

Check with the CDC Traveler’s Health website for more information on health safety when traveling to a specific location.

Travelers Diarrhea

This is the most common disease in travelers and is more severe in immunocompromised individuals. (2) It is very important to stay hydrated during the illness as dehydration can be very dangerous. If you are unable to maintain your hydration status and/or have severe symptoms, you should contact your transplant team immediately, or proceed to the nearest medical center.

Definition of travelers diarrhea is:

3 loose stools in 8 hours or
4 loose stools in 24 hours PLUS 1 of:
Nausea, vomiting, urgency
Abdominal cramps, fever

References:

Yadav P, Baddley J. Guide to Safe Travel after Transplant. Guide to Safe Travel after Transplant. 2018.
Kidney Health Australia, Harvey M. Transplant and Travel. Queensland