You are referred for a liver transplant assessment by your doctor after experiencing symptoms of liver failure.

During your first visit to the transplant center you meet your Transplant Nurse Coordinator, a Transplant Surgeon and the Transplant Clinic staff. You have your blood drawn to determine your blood type, your liver and immune system function, and screens for infectious diseases, which will include Hepatitis and HIV. At the end of your first visit, you will generally know if we will be proceeding with liver transplant evaluation. We will arrange a series of appointments for you.

Pre-Transplant Evaluation
A comprehensive series of tests help us learn more about your general health and discover any potential problems you may be facing. These tests take several days, and they are very important.

You may have many of the following exams and consults:

Chest x-ray	Colonoscopy
Electrocardiogram (EKG or ECG)	Liver biopsy
Cardiac stress test	Lab work and screening
Echocardiogram	Dental consult
CT (CAT)	Cardiologist consult
MRI (magnetic resonance imaging)	Social Work consult
Pulmonary Function Tests (PFTs)	Psychiatric consult
Upper Endoscopy	Dietary consult

Alcohol and Drugs
Alcohol and illegal drug use in persons with liver disease can cause further damage to the liver. We perform random drug and alcohol screening on ALL patients. You will not be considered for a liver transplant evaluation until you are drug and alcohol free for six months. 

Results of Assessment
After the assessment exams, the Transplant Team will review your results and determine the risks and benefits of transplantation for you. Your doctor will continue to treat your disease and keep you informed about the test results and the Transplant Team’s evaluation. If transplantation is recommended, you will have the final decision on whether your name is added to the waiting list.

After the committee has decided you are a good candidate, your medical records will be sent to your insurance carrier for final approval. Once the insurance has consented, you will be notified to have lab work drawn. Your lab results will determine your place on the transplant list.

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What is the waiting list?
The federal government created a national computerized network called OPTN (Organ Procurement and Transplantation Network) that is operated by UNOS (United Network of Organ Sharing), which regulates the distribution of all organs in the United States. All patients are listed according to a national point system and their blood type. More information about wait lists and transplants is available on www.UNOS.org. 

Your MELD Score
The Model for End-Stage Liver Disease (MELD) ranges from 6 (less ill) to 40 (gravely ill), used for liver transplant candidates age 12 and older. The number is calculated by a formula using three routine lab test results: Bilirubin, INR (prothrombin time) and Creatinine. More information on MELD scoring is available on www.UNOS.org

Factors affecting transplant wait time:
The time you must wait for a transplant depends on your MELD score, blood type, availability of suitable organs in our donation service area and your compliance to get new lab work done when requested.

The time spent waiting can be the most stressful phase of the transplant journey. You could wait for several months or several years. We cannot predict how long you will have to wait for a suitable liver to become available.

While you are waiting:

• Maintain proper nutrition and exercise as directed by your doctor
• Attend pre-transplant classes
• Keep yourself and your support system ready for the next step
• Take the prescribed medications, and do not take medications on the “do not take” list
• See the patient guide for more information.

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When a liver becomes available for you, a Transplant Coordinator will call you at the phone numbers you provide us. We will ask you to come to the hospital as quickly and safely as possible. Please be sure to bring your health insurance information with you to the hospital. Plan to be on your way to the hospital within one hour after we call you.

Additional instructions are available in the patient guide.

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When you arrive at the hospital, you will check in at the 12th floor Transplant Area. All of our transplant rooms are private, single patient rooms. Once you arrive there will be a lot of activity, including having the following examinations for the surgery:

• Physical examination by one of the doctors
• Blood work
• Chest x-ray
• Electrocardiogram (EKG)
• The nurses will place an IV (plastic catheter) in your vein for fluids and medications to be given
• The doctor will have you sign a consent to do the surgery and will be able to answer you questions

We may cancel your transplant surgery and send you home if:

• You have any signs of infection
• The donor liver has any problems
• A new medical problem exists
• You test positive for drugs or alcohol

The Transplant Surgeons will have this information before they take you to the operating room.

Procurement
While you are being prepared for surgery, the Transplant Team will be retrieving the donated liver. Most livers come from a deceased donor. Unlike other organs, the liver does not have to be a perfect match, but it must be from the same or compatible blood type. There is some consideration given to the donor liver size compared to your body size. We evaluate every donor liver by donor history, lab results, visual exam and biopsy, if indicated, to determine if the liver is right for you. It is possible the liver will not be suitable for transplant; in this case the surgery is canceled. If this happens, you will be sent home.

Surgery
Once confirmed that the liver is suitable for transplantation, you will be taken to the operating room. You will be given anesthesia. Transplant surgery usually lasts three to five hours. On the average, most patients require four units of blood. The surgical incision is shaped like a boomerang under your rib cage. Your old liver is removed and the new donor liver is attached to your blood vessels and bile ducts. Your family will wait in a room close to the operating room, and someone from the staff will keep them informed of your progress. The Transplant Surgeon will speak to your family once the surgery is complete.

After the Surgery
You will go directly to the Transplant Intensive Care Unit where you will spend the next two to three days. When your condition is stable, and you can breathe on your own, you will be transferred to a private room in the Transplant Telemetry Unit. Most patients are discharged from the hospital seven to ten days after surgery.

During Your Hospital Stay
A multidisciplinary team will be responsible for your care. Discharge Coordinators will teach you and your family about home care and post-transplant medications. You will also be seen by a Physical Therapist who will work with you to regain your strength. Your willingness to work hard is directly related to how well you will do after transplant.

Complications of Surgery
Remember that most transplant surgeries are successful; however, complications may occur after a liver transplant, including:

• Infections
• Bleeding
• Bile duct narrowing or leak
• Rejection
• Non-functioning donor liver, which may require re-transplantation
• Clotted vessels
• Death

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After you are discharged from the hospital, we will follow you closely for the first three months. You should plan for weekly outpatient follow-up appointments in the Transplant Clinic as we monitor your progress and adjust your medications.

Three to six months after transplant we start sharing responsibility of your care with your personal doctor. We strongly encourage you and your doctor to contact us with any questions or problems.

Medications After Transplantation
The body tries to dispose of anything that it considers foreign. To prevent rejection, we prescribe immunosuppressant medications that you will take for the rest of your life. Since these medications lower your immune system, we will also give you medications that will help your body fight infections.

A successful liver transplant is often directly related to your ability to take medications correctly. You must take all your medications exactly the way the doctor orders them. Each one of the medicines help you keep your new liver healthy. If you stop taking your medications, you will reject your transplanted liver and may damage it beyond repair.

These are some of the medications you will take:

• Immunosuppressants
• Steroids
• Antibiotics
• Antifungals
• Antivirals
• Antihypertensives
• Diuretics
• Vitamins and minerals
• Ulcer medications
• Insulin (if needed)

Don’t forget to consult the various prescription programs at local pharmacies to help you control your medication costs.

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