Liver transplantation patients are usually referred to the transplant center by their local physician or through case managers of insurance companies. The pre-transplant coordinator interviews the patient by phone, obtains the patient’s medical history, and schedules the patient for an evaluation for liver transplantation.
During the first phone call, the coordinator also explains the liver transplantation evaluation and selection process. Appointments for evaluation are generally scheduled as soon as possible, taking into account medical urgency.
The potential liver transplantation patient is asked to obtain outside medical records and imaging studies and bring these for review during the evaluation. An insurance review is conducted prior to the patient’s initial visit. Appointment schedules, maps, housing information, and education material are mailed to the patient.
The liver transplantation evaluation usually requires 3 full days of outpatient testing.
The informed consent process begins during the patient’s pre-transplant evaluation. Throughout the evaluation, patients are educated by the physicians and liver transplantation coordinator regarding the transplant procedure, postoperative care (including need for lifelong immunosuppression), and potential complications.
Patients with hepatitis B or C are informed of the need for HBIg infusions or interferon/ribavirin, respectively. The potential for use of donors with positive anti-HCV or HBcAb serology, other extended donors, or split livers is also reviewed with the patient during the evaluation, and the patient’s response is documented.
A thorough assessment of the patient’s support system, compliance history and motivation for liver transplantation is conducted by the social worker. Liver transplantation patients with a history of drug dependency undergo thorough evaluation by the chemical dependency counselor.