The Liver Transplant Process

In this section:

• Talk with your doctor about a liver transplant
• Visit a transplant center
• Get evaluated for a liver transplant
• Get approved for a liver transplant
• Get placed on the national waiting list
• Confirm living donor match if you choose this type of liver transplant

The liver transplant process has many steps, including talking with your doctor, visiting a transplant center, and getting evaluated.

Talk with your doctor about a liver transplant

The first step is to talk with your doctor to find out whether you are a candidate for a transplant. Doctors consider liver transplants only after they have ruled out all other treatment options. However, a liver transplant is not for everyone. Your doctor may tell you that you are not healthy enough for surgery. You may have a medical condition that would make a transplant unlikely to succeed. If you and your doctor think a liver transplant is right for you, your doctor will refer you to a transplant center.

Visit a transplant center

During your first visit to a transplant center, health professionals will provide information about

• the evaluation and approval process
• placement on the national waiting list
• reasons for being removed from the national waiting list
• the waiting period
• how people are selected for liver transplants
• surgery and recovery
• the long-term demands of living with a liver transplant, such as taking medicines for the rest of your life

Get evaluated for a liver transplant

You will go through a series of evaluations at the transplant center, where you will meet members of your transplant team. You may need to visit the transplant center several times over the course of a few weeks or even months.

Your transplant team

Your transplant team has many members. The team will include all or some of the following people:

• transplant coordinator—a specially trained nurse who will be your point of contact, arrange appointments, and provide information and education before and after your transplant.
• transplant surgeons—specially trained doctors who perform the surgery and provide care before and after your transplant.
• hepatologist—a doctor who specializes in liver disease and may provide care before and after your surgery.
• insurance case manager—a person who will help you with your insurance coverage.
• financial coordinator—a person who helps with financial matters.
• social worker—a person who can help solve problems in your daily life and coordinate care needs after your transplant.
• psychiatrist—a doctor who determines whether you are mentally and emotionally healthy and prepared for caring for a new liver.
• dietitian—an expert in food and nutrition. A dietitian can teach you about the foods you should eat and how to plan healthy meals before and after your transplant.

Your team will ask you about your medical history and perform medical tests. These tests may include

• a physical exam
• blood and urine tests
• tests that provide pictures of organs inside your body, called imaging tests
• tests to see how well your heart, lungs, and kidneys are working

The team will use the results of these tests to tell them

• how likely you are to survive transplant surgery
• what other diseases and conditions you have
• the cause and severity of your liver disease

Your team will find out if you are healthy enough for surgery. Some medical conditions or illnesses can make a liver transplant less likely to succeed. You may not be able to have a transplant if you have

• a severe infection
• alcohol or drug abuse problems
• cancer outside the liver
• serious heart or lung disease

Also, the transplant team will

• find out whether you or your caregivers are able to understand and follow your doctor’s instructions for care after your transplant. They need to be sure you are mentally prepared for caring for a new liver.
• find out whether you have a good support system of family members or friends to help care for you before and after the transplant.
• review your medical insurance and other financial resources. Many financial assistance programs are available to people receiving a liver transplant and their families to help with the cost of the surgery, medicines, and care.

Get approved for a liver transplant

The transplant center’s selection committee will review the results of your evaluation. Each transplant center has its own guidelines about who can get a liver transplant. Transplant centers often post their guidelines on their websites. The centers also follow national guidelines.

Keep in mind that you may choose not to have a transplant even though you have been approved.

Get placed on the national waiting list

If you are approved for a transplant and do not have a living donor, the transplant center will submit your name to be placed on the national waiting list for a liver from a deceased donor. If you have a living donor, the transplant center will not place you on the national waiting list.

The Organ Procurement and Transplantation Network (OPTN) has a computer network linking all regional organ-gathering organizations—known as organ procurement organizations—and transplant centers. The United Network for Organ Sharing (UNOS), a nonprofit organization, runs the OPTN under a contract with the Federal Government. When UNOS officially adds you to the national waiting list, UNOS will notify you and your transplant center.

UNOS policies let you register with more than one transplant center to increase your chances of receiving a liver. Each transplant center may require a separate medical evaluation.

Wait for a match

The waiting period for a deceased donor transplant can range from less than 30 days to more than 5 years.4 How long you will wait depends on how badly you need a new liver. Other factors—such your age, where you live, your blood type and body size, your overall health, and the availability of a matching liver—may make your wait time longer or shorter. The UNOS computer matches a deceased donor’s liver based on your blood type and body size.

UNOS policies rank people with the most urgent need for a new liver to prevent death at the top of the national waiting list.

When a matching liver from a deceased donor is found, your transplant team coordinator will call you right away, tell you what you need to do before going to the hospital, and ask you to come to the hospital right away.

Confirm living donor match if you choose this type of liver transplant

If a family member, spouse, or friend wants to be a living donor, the transplant team will determine whether you and the person have blood types that work together and a similar body size. The transplant team will

• ask the potential donor about his or her medical history
• perform medical tests to make sure the person is in good general health, with no major medical or mental illnesses

The potential donor must be able to understand and follow instructions before and after surgery, be between the ages of 18 and 60, and have an emotional tie to the person receiving the liver transplant.

The OPTN and UNOS provide detailed information on the organ transplant process.

References

4] Organ Procurement and Transplantation Network. Health Resources and Services Administration, U.S. Department of Health and Human Services. National data website. [https://optn.transplant.hrsa.gov/data/view-data-reports/build-advanced. Based on OPTN data as of February 1, 2017. Accessed February 2, 2017.

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