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They can. Without the donor organ being fully connected into the patient's body, there is no way to know if it's going to work or not. Obviously, the previous organ has (usually) been removed by this point (exception being in kidney transplants, or "piggy back" transplants), so if the new organ does not work, you're slightly stuck...

If the organ has had a long time from being harvested from the donor to going into the patient, the odds of it not working become higher. Also, the experience of you surgeon does influence whether an organ transplant works or not (however inexperienced surgeons are not allowed to operate without the guidance of a more experienced surgeon).

Also, 'organ rejection' can cause transplants to fail. (But this does not equate to death of the patient - some rejection is treatable with drugs, the rest (whom drugs do not work for) require a re-transplant).

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