Evaluation of Candidates for Liver Transplant
Potential liver transplant candidates will complete an evaluation process that includes a variety of blood test, procedures and consultations. Defining a clear picture of your health increases the likelihood of a successful outcome; therefore, transplant candidates must undergo tests to determine their heart, lung and kidney function. It is necessary to assess the abdominal organs and look for clotting of the liver vessels and tumors. Multiple tubes of blood and several urine samples are needed to assess the function of your immune system, kidneys, liver and general health. Blood samples will also be used to screen for viruses, evidence of cancer and cause of liver failure.
As part of your medical evaluation, you will meet with a team doctors and auxiliary staff. These include:
- Transplant surgeon
- Transplant coordinator
- Social worker
At the evaluation conference you will meet with a transplant coordinator, who is a registered nurse specializing in organ transplantation. The educational meeting is conducted by the transplant coordinator. This meeting will describe all aspects of the transplant process. You are encouraged to bring family and friends to this meeting. The discussion includes detail of how candidates are selected for transplantation, risks and benefits, complications of the procedure, hospital routines, and care after you leave the hospital. Prior to this meeting you will be sent a transplant informational packet to review. During the educational session, ample opportunity will be provided for you to ask questions and discuss your concerns. The transplant coordinator will assist you and your family through preparation, education and listing.
The UI Hospitals and Clinics transplant team has a multidisciplinary approach, which stresses the importance of treating individuals as a whole. We recognize the importance of the patients emotional and mental needs, as well as physical needs. A transplant social services representative will meet with you at your evaluation. The social worker gathers information about you and your family, your coping abilities, substance abuse history, support systems and ability to follow important post transplant instructions. This information helps the social worker determine your needs while you are in the hospital and how to better prepare you for the transplant experience. The social worker provides emotional support, information, helps plan for your discharge and can help you explore appropriate groups and service agencies in your local community.
Approval for Transplantation
When the evaluation is completed, the transplant committee will review the results of tests, procedures, and consultations. This committee meets every Monday and consists of the nurses, physicians, social workers and others who you have met throughout the evaluation process. Each member contributes their opinion; and a decision is made with regard to further testing, additional treatment and when you should be added to the waiting list.
If you are approved for transplantation, you will be placed on the recipient list of the United Network for Organ Sharing (UNOS). Liver recipients are matched to donor according to blood type, height and weight, staging and waiting time on list.
In select circumstances, living liver donation may be considered. Individuals must go through a thorough evaluation before being considered as a potential donor. If a family member qualifies as a donor and the transplant team feels this is your best option
It is important the liver donor is absolutely willing to be considered. Living liver donation is an emotional decision. It is natural to feel fear and anxiety over the procedure, while maintaining a strong desire to participate. Our hope is to maintain the relationship between patient and donor, regardless of donation decision.
The following timeline is representative of the typical liver recipient; no patient will have exactly the same experiences.
Day of Surgery
- You will be admitted directly to the transplant unit
- Blood samples will be obtained
- A chest x-ray and EKG will be obtained
- An enema will be given to cleanse the bowel
- You will go to surgery within hours of being admitted
- Usually lasts two to four hours
Immediately Post-Op to Post-Op Day 2: Intensive Care
- You will go to the Surgical and Neuroscience Intensive Care Unit (SNICU) until you are awake, breathing on your own, and stable; usually between 12 hours and two days.
- While in SNICU, you will be connected to numerous monitoring lines and tubes and will be somewhat sedated at first. You will be connected to a ventilator with a tube going down your windpipe to help you breathe. You will not be able to talk while this tube is in place, but your nurse will help you communicate in other ways. You will have a tube going down your nose into your stomach to suction out gastric secretions. You will have a Foley catheter inserted into your bladder to drain your urine. You will have a special monitoring IV line in one of your wrists to monitor your blood pressure and through which blood may be obtained. You will have a special IV in your neck or chest. You will be hooked up to a heart monitor.
- You will not be able to eat or drink while in SNICU, but may have your mouth moistened with swabs.
- When you are breathing on your own and stable, you will go to the Transplant Unit.
Post-Op Day 2 to Post-Op Day 9: Transplant Unit to Discharge
Post-Op Day 2:
- The transplant nurses will help you to get out of bed the same day you transfer from the SNICU; this may just be getting up to a chair, but many patients take a short walk. You will be encouraged to increase your activity every day in order to speed recovery and prevent complications such as blood clots and pneumonia. You will also be encouraged to cough and deep breathe at least every two hours to help prevent pneumonia.
- The transplant nurses, pharmacist and dietitian will begin teaching you how to take care of yourself and your new liver. You will be expected to learn the new medications you will be taking to prevent rejection and infection. You will be expected to be able to state the signs and symptoms of both rejection and infection.
- You will probably still have the IV in your neck or chest. If not, you will have a regular IV in one of your arms or hands. You may still have the tube going into your stomach. When your bowel begins to wake up from surgery (as evidenced by bowel sounds and/or passing gas), you will be able to have the suction tube removed from your stomach and begin drinking liquids. You will still have the Foley catheter to drain your urine. When you are strong enough to get up to use the bathroom several times a day, and there is no longer a need to closely monitor your urine output, you will be able to have the Foley catheter removed from your bladder. You may still be hooked up to a heart monitor.
- Blood will be drawn once a day from your arm to monitor your liver function and the blood levels of the medications you are on. This will continue until discharge.
Post-Op Days 3 to 5
- You will continue to learn how to take care of yourself and your new liver.
- You will have the tubes going into your stomach and bladder removed.
- You will probably be able to start eating solid foods by now.
- You will be walking at least four times a day, with assistance as needed.
Post-Op Days 6 to 9 (Discharge)
- A transplant coordinator nurse will speak with you to arrange for local laboratory blood work and further follow-up.
- You will be independent in your self-cares by discharge.
- You will know the medications you are taking, the dosages, purposes, and some of the side effects by discharge.
- You will know these signs and symptoms of rejection before discharge:
- Pain around liver
- Flu-like symptoms
- Dark urine
- Clay-colored stools
- You will know these signs and symptoms of infection before discharge:
- Redness at incisions
- Pus-like drainage
- Flu-like symptoms
- You will know to report any signs and symptoms of rejection or infection to the transplant staff, and how to do this. You will know other information to report. All this material will be written down for you to take home.
- You will know when you need to come back to the hospital for your first outpatient clinic appointment - you will be seen weekly for the first month or so. Frequency of clinic appointments will decrease as you continue to do well. You will know where to go to get blood drawn near your home. Typically, you will have blood drawn each time you come to our clinic appointments on Tuesdays, and you will also have blood drawn at a local laboratory on Fridays. The frequency of blood draws also will decrease as you continue to do well.