Transplant Center

To be considered as a candidate for liver transplantation, you will first undergo a thorough transplant evaluation. The evaluation will help our transplant team learn more about you and your disease, and provide you with the opportunity to learn more about our liver transplant team and transplant program. The evaluation is an important part of the transplant process because it will:

• Confirm your diagnosis and determine the extent of the liver injury or disease.
• Assess other medical or psychological problems affecting your health.
• Provide information about the risks and benefits of transplantation.
• Review your financial benefits and discuss the financial considerations associated with a transplant.
• Answer any questions you and your family may have.

The transplant evaluation usually takes place over three to four days and is done on an outpatient basis unless an inpatient stay is necessary. The evaluation includes but is not limited to the following tests:

• Laboratory studies (including HIV test)
• Chest X-ray
• Electrocardiogram (EKG)
• Dobutamine stress Echocardiogram/stress test (looks at blood flow through the heart and heart valves)
• Cardiac catheteritzation (if indicated)
• Doppler Ultrasound (looks at blood flow to and from the liver)
• Pulmonary function tests

Consultations with transplant team members including:

• Liver physician
• Liver surgeon
• Transplant nurse coordinator
• Social worker
• Dietician
• Psychiatrist
• Psychologist
• Financial coordinator
• Cardiologist (if age >50 or other indications)
• Pulmonologist if indicated
• Endocrinologist if indicated

Upon completion of the evaluation, your results will be presented at the multidisciplinary transplant team meeting. They will carefully review all the information from the evaluation and give their recommendation of the best treatment option for you. You will then be contacted by a transplant coordinator to discuss the plan of care.

Waiting for Transplantation

If liver transplantation is the best option for you and you agree, your name will be placed on a national waiting list based on blood type, body size (height and weight) and medical urgency. This can be a difficult time for you and your family because there is no way to know when a suitable donor will become available. Members of the transplant team are always available to you during this time.

Status on the List (medical urgency)

There is a system in place thorough an organization called the United Network for Organ Sharing (UNOS) to ensure all patients in need of transplantation are given a fair and equitable chance to receive an organ. UNOS is regulated by the federal government which in turn monitors the list and the listing practices of all transplant programs.
Priority for transplantation is based on the MELD score (Medical End-Stage liver Disease score). The MELD score is calculated using three lab values: bilirubin, prothrombin time/INR (clotting factors) and creatinine (kidney function). Sodium is also being looked at but not used as part of the calculation at this time. When calculated the scores range from 0 to 40 with a MELD score of 40 representing the sickest patient. It is very important that you have lab tests done when requested to be certain your score reflects your level of illness.

During the waiting time some patients may become too sick to receive a transplant (the chance of recovery very poor). If this happens, the Transplant Team may decide to make the patient "inactive" on the list and monitor their progress. If the patient's condition improves the team may then make the patient "active" on the list. Patients are notified of any changes in their listing status.

Organ Donors

One of the reasons we cannot predict the timing of a transplant has to do with the shortage of organ donors in the United States and the increasing numbers of people whose names are placed on transplant waiting lists. There are two types of organ donors: deceased donors and live donors.

Deceased Donors

Deceased donors are people who have suffered brain death. Deceased donors must be on life support (breathing machine) so the organs are not without oxygen. The next of kin must also give consent for donation unless the donor has a legally signed donor card. Families often have questions about the donor, but to maintain privacy and confidentiality we cannot release this information. We encourage transplant patients to write to their donor families and over time, some of these families have met.

Live Donors

Live donors are often family members or close friends who meet the criteria for donation and volunteer to give part of their liver to the transplant patient. The advantage of live liver donation is the decrease in waiting time. If you have a friend or relative who is interested in live donation we encourage them to call 800-401-4444 and speak with one of the transplant coordinators for more information.