Two rare complete intestine transplants were conducted in the United States in recent weeks.

A Washington state woman underwent a rare full intestine transplant in August. Savanna Oberts, the 26-year-old woman, also received a pancreas and liver during the surgery. It was the first time an adult had a transplant of this type at the University of Washington Medical Center.

Oberts had to had to wait five years to find a suitable donor with the right tissue type and size. Organ failure prompted doctors to keep her hospitalized until a donor was identified.

"Her condition was desperate," Dr. Jorge Reyes, the UW Medicine chief of transplant surgery who performed the 16-hour operation, told The Seattle Times. "You might say it was a last resort."

Reyes has performed or participated in about half of the 2,745 intestinal transplants conducted in the U.S. since 1990. It's a rarely performed surgery given the complexity of the situation. Reyes said it takes a highly skilled, multidisciplinary team to manage everything that could go wrong.

"It takes 10 times the effort to take care of these patients and a system that can understand the complexity of these patients," he said.

The second intestinal transplant was conducted at Holtz Children's Hospital in August in Miami.

Tony Forte, an 11-year-old Pennsylvania boy, received a transplant of a large and small intestine, stomach, liver and pancreas. He was diagnosed with complete intestinal Hirschsprung's disease.

Forte had most of his colon removed as a baby and has survived with a Broviac Catheter in his chest for nutrition, an ostomy bag and a G-Tube. The surgery was successful, and Forte was expected to stay about a month in the hospital.

According to federal Organ Procurement and Transplantation Network, most full intestine transplants are done in conjunction with a liver transplant. In some cases where only a partial transplant is needed, a living donor can give a portion of his or her intestine to a patient.

In Oberts' case, the intestinal transplant was truly a last resort. She had short bowel syndrome, a condition that kept her body from absorbing nutrients from food, vitamins, minerals and water. She received total parenteral nutrition (TPN) every night for five years to give her body nutrition. In recent months, the treatment began to fail and Oberts' liver started to fail.

"TPN is not nutrition, it's a drug," explained Reyes, who likens it to chemotherapy for cancer. "TPN failure is a problem of liver toxicity."

A failing intestine also causes the immune system to fail which caused Oberts to be prone to infections. She was frequently hospitalized and during an admission over the summer, Dr. Reyes decided not to discharge her until the transplant could be done.

So far, Oberts is doing well though she hadn't yet been discharged from the hospital in early September.

Outcomes among children who undergo complete intestine transplants depend largely on the underlying disease state. Between 1991 and 2008, 852 children had an intestine transplant. Of those, gastroschisis was the most common diagnosis followed by necrotizing enterocolitis,volvulus, other causes of short-gut syndrome, functional bowel syndrome and Hirschsprung disease.