Sarah Hyland recently revealed that she’s undergone not one but two kidney transplants within six years, and while it seems taxing and traumatic, it’s more common than one might think.
Young people who require a kidney transplant — Hyland was 21 when she had her first — will often need multiple transplants over the course of their life, says Dr. Robert Montgomery, Director of the Transplant Institute at NYU Langone Health, to PEOPLE.
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Hyland, now 28, suffers from kidney dysplasia, a condition she was born with after the organs did not fully develop in the womb, which causes frequent and painful cysts and reduced function. So, in April 2012, her dad donated his kidney.
But, she revealed in an interview with SELF published Monday, her body rejected it, and her younger brother Ian, 23, became her next donor in Sept. 2017.
So why did the first kidney last only six years?
While Dr. Montgomery concedes six years is “relatively short,” he often tells his patients, “Transplanted kidneys are not like diamonds. They don’t last forever.” He adds that the most common factors that affect how long a kidney lasts are “the quality of the donor organ, episodes of rejection and the development of harmful antibodies that attack the kidney.”
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Chronic rejection, which Hyland mentioned in the SELF interview, can cause low-grade injury to the kidney, resulting in too much scar tissue and reduced function, Dr. Montgomery explains. Somewhat luckily for Hyland, though, a second transplant surgery isn’t usually more painful, according to Dr. Montgomery.
“The new kidney will be placed on the other side of the abdomen from the other one and the surgery (and pain) will be similar to the first kidney transplant,” he says.
The bigger issue is the “immunologic standpoint,” the doctor adds. “Patients can become sensitized to transplant tissue, and this makes them harder to match, can cause them to wait longer for a transplant, and may require specialized techniques to enable a second transplant.”
RELATED VIDEO: Sarah Hyland Reveals She Had a Second Kidney Transplant and ‘Was Contemplating Suicide’
A source recently confirmed to PEOPLE that Hyland is, in fact, struggling with her immune system.
“She’s now healthy when it comes to her kidneys. She’s doing well, and her levels are all good,” the insider explained. “But she is taking immunosuppressant drugs that make her very vulnerable to germs and disease so she has to be so cautious.”
Even though the medical reasons for requiring a second kidney are entirely out of Hyland’s control, the Modern Family star shared that she still sometimes feels like she’s letting her family down. She told the magazine the entire situation left her “very depressed” and had her “contemplating suicide.”
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Hyland also has endometriosis, which, along with the kidney dysplasia, has required her to undergo six surgeries over the past 16 months. There’s no known connection between the two conditions, Dr. Montgomery says.
Finally, 14 months after the second surgery, the source says Hyland is in a better state of mind — but she still faces mental struggles because of her illnesses. When her endometriosis flares up, it’s incredibly painful.
“Not only has all of this been physically demanding, but the emotional and mental demands have been just as challenging,” the insider said. “She has a chronic illness and she will have to deal with it for the rest of her life. She’s still working through it all.”
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