The Work up Process

After successfully completing your initial pre-transplant evaluation, your transplant coordinator will begin scheduling appointments for testing and procedures needed prior to transplant. Some of these tests or procedures will need to be updated annually. Your transplant coordinator will notify you when a test or procedure needs to be updated. It is important to keep up with your tests and procedures so that you can be transplanted when you get the call.

Required Testing

• Simple blood tests including blood typing

• EKG

• Chest x-ray

• Dental exam

• Abdominal Ultrasound

• Coronary Angiogram (For all patients over 45, diabetic, or risk factors/history of heart disease)

• Cardiology consult (If you have risk factors, are diabetic or over age 45)

• Colonoscopy (For all patients over the age of 50)

• Mammogram and Pap smear for all women over the age of 40

• Recent Prostate Specific Antigen (PSA) for all men over the age of 40

All patients will be presented at the Patient Selection Committee Meeting (PSC) after they have completed all their testing and have been seen by the multidisciplinary transplant team.

The purpose of the PSC is to review the results of testing, discuss visits with the multidisciplinary team, and to determine if they qualify for placement on the transplant wait list.

The results of the PSC discussion will be conveyed to the patient and referring physician within 10 days.

If you are approved and cleared by the multidisciplinary team in PSC, you will be added to the National Waiting List for liver transplant. You will be placed on the waiting list based on your blood type and antibody test.

The national organ waiting list is managed by an organization called the United Network for Organ Sharing (UNOS), a private, nonprofit agency that works with the federal government. UNOS keeps track of all the people in the United States who need liver transplants, and matches them with donors.

If you are not approved for listing at the time of PSC, your transplant coordinator will explain any additional testing or requirements to get you listed for transplant. On some occasions, you may not qualify for transplant. Your coordinator will explain in detail as well as send a letter to your primary doctor explaining the reasons you cannot be transplanted at this time.

Organ Offers

When a suitable donor is found, the surgeon and coordinator will first review donor history and testing results. If the offer is suitable for you, the surgeon will give the OK to admit you for your transplant. In some cases, the surgeon or transplant coordinator may call and discuss the organ offer with you.

Getting the Call

Once you have received a call from the coordinator and you have accepted the organ offer, you will then be instructed to arrive at St Vincent as soon as possible. Please drive to St Vincent with as many important members of your family as necessary.

Your coordinator will ask you the following questions:

• What time did you last eat or drink anything?

• Have you had any recent admissions to the hospital or new health problems?

• Have there been any changes to your life situation (ie, support, financial, or emotional states that may impact your post-transplant care

Once these questions have been answered, you coordinator will instruct you not to eat or drink anything and come to the hospital. If you are diabetic, please inform the coordinators so that instruction about medication dosing can be given. You should bring all current medications and a bag with a set of clothes and other essentials for hospital admission.

Arrival to the Hospital

We strive to proceed with transplant ASAP, however we realize there may be need for further evaluation. You will be directed to Admissions and then the floor for nursing assessment, have some additional testing done including blood work, EKG, and chest xray, and any other testing that needs to be updated since your last clinic visit.

On arrival to the hospital, you will be greeted by your surgeon. He will prefer to speak to you and your family members about the details of the process, including risks and benefits.

The Transplant Operation

The process of anesthesia, prior to the actual surgery starting, can take 1-2 hrs. The anesthesia portion involves sedation, paralysis, intubation (insertion of a breathing tube), IV lines (arterial, central venous, cardiac monitoring), and occasionally transesophageal echocardiography.

In addition, prior to surgery a catheter will be placed into your bladder to drain urine and tube in our stomach via your nose (nasogastric tube). These catheters are generally removed on post op day 3-4. On rare occasion depending on your condition – the catheters may stay longer.

In some instances, surgery starts by proceeding with incisions made in your upper chest and grown for placing large IV lines to allow for blood “bypass”. Once this is completed an incision on your abdomen.

Your old liver is removed and your new one is replaced.

The two veins, one artery, and bile duct of the new liver all require surgical reconstruction. These are major blood vessels in the body and extreme care is taken during the re-sewing of these vessels.

Surgery time varies from 6 hours to as long as 14 hours. More or less time does not mean better or worse results. Every patient is different and unique in their own way that can affect surgery time.

On rare occasions there is a planned scenario to bring the patient back to the operating room during the course of the next 1-3 days. This is often not related to complications but more so related to anticipated staging steps of the operation for certain people. You are then awakened and transported to the recovery room or directly to the intensive care unit (ICU). While in the ICU your blood pressure, heart rate and lung oxygen exchange will be closely monitored. The ICU is a busy location with critical patients and thus family visits and intervals are limited. Once your doctors consider your condition stable they will then transfer you to the transplant floor outside the ICU.