Intestinal Transplant

Small Intestine Transplant for Intestinal Failure

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Duke is among the few hospitals in the U.S. where transplant surgeons perform intestinal transplants. The rare, complex procedure can be a lifesaving option when disease, trauma, or problems with a previous bowel resection surgery prevent nutrients from moving through the intestines and being absorbed by the body. 

Our surgeons have performed more than 50 intestinal transplants since the program began in 2009. We help you through every step of this journey, from managing your condition before the transplant through recovery and follow-up. We are here for you.

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Intestinal Failure Treatment Options

Duke has a long history of treating adults with GI conditions including Crohn’s Disease, short bowel syndrome, trauma, a small bowel tumor, and others, all of which can lead to intestinal failure. Intestinal failure treatments may include:

  • Intestinal rehabilitation, which uses medication or surgery to restore your body’s ability to absorb nutrients and possibly delay the need for transplant
  • Total Parenteral Nutrition (TPN) to deliver nutrition intravenously through a catheter

However, if your condition is life-threatening, an intestinal transplant may be a better alternative. 

Our Locations

Duke Health offers locations throughout the Triangle. Find one near you.

Becoming an Intestinal Transplant Candidate

Extensive Evaluation

The first step is an extensive evaluation with our team to determine whether intestinal transplantation is the appropriate therapy. The process may include blood tests and X-rays,. Our transplant coordinator will help you navigate through this evaluation.

Liver Biopsy

Removes a small amount of tissue from the liver to help us determine the health of the organ. If there is a lot of scar tissue, you may also need a liver transplant at the same time as your intestinal transplant. 

Living Donor Evaluation

Duke is one of 10 transplant centers in the U.S. offering living donations of the small intestine. This may be an option for you if you have a close family member like a parent or sibling willing to donate a portion of their small intestine. They will undergo a comprehensive exam, testing, and interviews with the transplant team. Living donors must be healthy and have compatible blood and tissue types.

New Patient Appointment

Intestinal Transplant Process


If the evaluation shows that intestinal transplantation would be appropriate for you, you will be listed in the national waitlist maintained and administered by the United Network for Organ Sharing (UNOS). Once you receive notification that an organ is available, you will need to arrive at Duke within six hours.

Transplant Education

You and your caregivers will participate in transplant education classes to learn more about the experience, the medications you will need, and how to address your physical and emotional needs before and after transplant. If you need to temporarily relocate to the Durham, NC, area for your treatment, a transplant coordinator and a social worker can also assist you in gathering resources and support.

Transplant Surgery

Your surgeon will make an incision in your abdomen. Your small intestine and its blood vessels will be removed and replaced with the donor organ. An opening called a stoma will be created in the small bowel or colon to allow the transplant team to monitor your transplanted organ after surgery. In most cases this is temporary. While the stoma is in place, stool will drain into a bag.


Following the intestinal transplant, doctors will closely monitor your response to the surgery. We will prescribe and manage medications to prevent rejection. In addition, we perform routine small-bowel biopsies to monitor the transplanted graft. The length of time patients spend in the hospital post-transplant can vary from one to three months. After leaving the hospital, you will stay within one hour of Duke for follow-up care before returning home. This can range from three to six months or longer, depending on your progress.  

Your Caregivers Are Our Partners

We involve your designated caregivers (family members or friends) from the time of your first evaluation through recovery. They attend each of your appointments, and we educate them about their important role in taking care of you before and after surgery. Since a caregiver should attend all appointments with you, we often recommend you choose two caregivers, in case one is not able to attend an appointment or if it is better for two caregivers to take turns caring for you.

Best Hospital for Gastroenterology and GI Surgery in NC

Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our gastroenterology and GI surgery program is nationally ranked, and the highest-ranked program in North Carolina, according to U.S. News & World Report for 2023–2024.

Your Intestinal Transplant Team

Experts in Intestinal Transplant
The Duke intestinal transplant program is led by experts in hepatology (care of the liver) and transplant medicine. Many hold leadership positions in the Intestinal Rehabilitation and Transplant Association, the American Society of Transplantation, the American Society of Transplant Surgeons, and the United Network for Organ Sharing (UNOS). Our transplant surgeons have successfully treated people who have been declined for an intestinal transplant at other hospitals. In addition to intestinal transplants, we perform multi-organ transplants that include the small intestine, liver, pancreas, stomach, colon, and kidney.

Leaders in Intestinal Transplant Living Donation 
Living donor intestinal transplants – which use a portion of the small intestine from a living donor instead of a deceased donor -- can help reduce time spent on the transplant waitlist so you can have the life-saving surgery you need more quickly. Duke is one of a handful of centers in the U.S. offering this advanced procedure.

Dedicated Hospital Unit for Transplant Patients
Our solid organ transplant unit is dedicated to caring for people throughout their organ transplant journey, whether they are waiting for a transplant, recovering from surgery, or returning to the hospital. The unit is staffed by a dedicated team of providers experienced in caring for people undergoing liver, kidney, small bowel, pancreas, or intestinal transplants. These include doctors, nurses, pharmacists, social workers, patient coordinators, and more. Patients and their families can establish relationships with our providers and staff and feel secure in the hospital environment.

Access to Clinical Trials
Our national involvement includes participation in clinical trials that test new therapies designed to improve nutrient absorption in people with intestinal failure, and ways to reduce transplant rejection. You or your loved one may be eligible to participate.

Dedicated Transplant Coordinator
Our team also includes transplant coordinators who help you navigate the process. These advanced-care nurses and our social worker can answer questions you or your caregivers may have about the wait time before the small bowel transplant, the surgery, financial concerns, physical and emotional issues, dietary requirements, and more.

On Call 24/7/365
For urgent matters, a transplant coordinator is on call 24 hours a day, 365 days a year. Additionally, an intestinal transplant doctor is on-call at all times for any needs that arise.

This page was medically reviewed on 02/27/2024 by