What tests are required before getting a liver transplant?
You will need to bring all of your medical records, X-rays, liver biopsy slides, operative reports, and a list of medications to your pre-evaluation. To complement and update previous tests, some or all of the following studies are usually performed during your evaluation:
- Computed tomography (CAT or CT scan), which uses X-rays and a computer to create pictures showing liver size and shape, blood supply, and any liver lesions. A chest CT scan may also be needed.
- Doppler ultrasound to determine if the blood vessels to and from your liver are open
- Echocardiogram and stress testing to help evaluate your heart
- Pulmonary function studies to determine your lungs' ability to exchange oxygen and carbon dioxide
- Blood tests to determine blood type, clotting ability, and biochemical status of blood, and to measure liver function. Serology screening (a blood test that looks for antibodies) is also included.
If these tests reveal specific problems, the medical team may order additional tests.
How does the liver transplant waiting list work?
If you become an active liver transplant candidate, your name will be placed on a national waiting list. Patients are listed according to blood type, body size, and the model of end-stage liver disease/pediatric end-stage liver disease (MELD/PELD) score.
The MELD/PELD score is calculated by simple blood tests (creatinine, bilirubin, and INR). Patients with the highest scores are assigned organs first.
Your transplant team will determine if a particular donor organ is a suitable match for you. As patients become more ill, their scores may increase and their priority for transplant increases, allowing for the sickest patients to be transplanted first. A small group of patients who are critically ill from acute liver disease have the highest priority on the waiting list.
It is impossible to predict how long a patient will wait for a liver to become available. Your transplant coordinator is always available to discuss where you are on the waiting list.
Where does a liver for a transplant come from?
There are two types of liver transplantation options: living donor and cadaveric.
Living donor liver transplants are an option for some patients with end-stage liver disease. In this procedure, a segment of liver is removed from a healthy living donor and implanted into a recipient. Both the donor and recipient liver segments will grow to an adequate size in a few weeks.
The donor, who may be a blood relative, spouse, or friend, will have extensive medical and psychological evaluations to make sure there is as little risk as possible. Blood type and body size are important factors in determining who is an appropriate donor.
Recipients for the living donor transplantation must be active on the transplant waiting list. Their health must also be stable enough to undergo transplantation with excellent chances of success.
In cadaveric liver transplantation, the donor may be a victim of a cerebral vascular accident or head injury, such as spontaneous bleeding into the head. There are two types of cadaveric donors, both involving patients who have suffered irreversible brain injury:
- In a donation after cardiac death, the brain injury is very extensive but the patient does not meet brain death criteria. The family has agreed to withdraw support, and it is done in a controlled setting. After the heart has stopped, the donor is declared dead and organs can be removed.
- In brain dead donors, there is no longer any brain activity but the heart has continued to beat.
The identity of a cadaveric donor and circumstances surrounding the person's death are kept confidential. It is considered an anonymous “gift.”
Hospitals will evaluate all potential donors for evidence of liver disease, alcohol or drug abuse, cancer, or infection. Donors will also have serology testing and testing for other infections. If this screening does not reveal problems with the liver, donors and recipients are matched according to blood type and body size. Age, race, and sex are not considered.
The transplant team will discuss your transplantation options with you at the time of your pre-transplant evaluation, or you can contact the transplant team for more information.
What happens when a matching organ is found?
When an organ has been identified for you, a transplant coordinator will call you. Do not eat or drink anything once you have been called to the hospital. The transplant coordinator will let you know of any additional instructions.
When you arrive at the hospital, you will have additional blood tests, an electrocardiogram, and a chest X-ray before the operation. You also may meet with the anesthesiologist and a surgical resident. If the donor liver is found to be acceptable, you will proceed with the transplant. If not, you will be sent home to continue waiting.
What happens during the liver transplant operation?
Liver transplants usually take from six to 12 hours. During the operation, surgeons will remove your liver and replace it with the donor liver.
Because a transplant operation is a major procedure, surgeons will need to place several tubes in your body. These tubes will help your body carry out certain functions during the operation and for a few days afterward.
- A tube will be placed through your mouth into your trachea (windpipe) to help you breathe during the operation and for the first day or two after. The tube is attached to a ventilator that will expand your lungs mechanically.
- A nasogastric tube will be inserted through your nose into your stomach to drain secretions from your stomach. It will remain in place for a few days until your bowel function returns to normal.
- A tube called a catheter will be placed in your bladder to drain urine. This will be removed a few days after the operation.
- Tubes will be placed in your abdomen to drain blood and fluid from around the liver. These will remain in place for about a week.