The Recanati/Miller Transplantation Institute

Programs

Liver Transplantation

Adult Liver: Preoperative Experience

Introduction | Referrals | Evaluation | Preoperative Experience |
Postoperative Experience | Retransplants/Recurrent Diseases |
Transplantation for Liver Tumors | Research

Waiting on the List

Once you are accepted for transplantation, the search for a suitable donor begins. All patients are entered onto the national transplant waiting list maintained by UNOS (The United Network for Organ Sharing), a national organization that works 24 hours a day, 365 days a year to match donors to recipients. In order to fairly and efficiently distribute this scarce resource, the country is divided into regions, so most of the organs that come to Mount Sinai are from donors in the State of New York. We look for a donor who has a compatible blood type and similar body weight to our waiting recipient.

The amount of time you spend on the waiting list is determined by many factors including blood type and the urgency of your condition. In February of 2002, UNOS implemented an updated system for organ allocation. The new system, MELD (Model for End State Liver Disease) gives liver transplant candidates a "score" based on how urgently they need a transplant. The MELD score is based on objective (non-biased) medical criteria and is calculated by inserting laboratory blood test results into a formula. As your test results change, so will your MELD score. As you become more in need of a transplant, your score will increase and you will move up on the UNOS list, thereby receiving greater priority for organ offers.

Unfortunately, due to the shortage of donor organs, the waiting time can be long and it is very important that during this time you do your best to maintain good health through a balanced diet and light exercise. Our staff will provide you with helpful guidelines.

While on the waiting list, you will have follow-up appointments with your own physicians as well as regular appointments in our office, which provide the opportunity to talk with the transplant surgeons, hepatologists and transplant coordinators. It is at this point that we will start vaccinations against certain viruses and bacteria that sometimes develop after transplant surgery when immunosuppression medication increases the risk of infection. In the event of a long waiting period, certain tests, such as the CT scan, that were performed during the initial evaluation may need to be repeated.

It is very important that you stay in close communication with the transplant team for the duration of the waiting period. If there are any major health changes, or if you are hospitalized for any reason, the transplant team must be notified. As you move higher on the waiting list, we strongly recommend that you get a beeper so we can contact you at any time without restricting you to waiting by the home phone. If you will be out of town at any point during the waiting period, but especially when higher on the list, be sure to give the transplant team a contact number and the dates you will be away.

The Transplant Procedure

When a suitable donor has been identified, you will receive a call to come into the hospital to be admitted. This call could come at any time and often happens at night so it is important to be prepared.

Upon arrival for surgery, you will undergo a series of tests and be given immunosuppression medications and antibiotics as part of your preparation for the operating room. Because of the limited time available, your preparation will happen while another surgical team is simultaneously retrieving the donor liver.

The average liver transplant operation takes between six and eight hours. Your family is invited to wait in the Surgical Family Waiting Room and will be kept abreast of your progress by a member of the transplant team. The transplant surgeon will speak with your family in this waiting area when the operation is over.

Patient Education

Patients with liver disease who may need a liver transplant are dealing with a very complex medical condition so it is important to be an informed and educated participant in your care. You as well as your immediate family should have a good understanding of all aspects of the transplant process such as your current condition, what to expect from the transplant procedure and how to recognize and handle any complications that may develop both pre and post operatively.

Because education for patients and their families is vital to the success of the transplant procedure, we provide thorough education for our patients in a variety of formats including written manuals, regular classes, and inpatient video systems.

As a transplant patient, you will be given two written manuals, one for Pre-Transplant and one for Post-Transplant. Both will provide comprehensive information about what to expect throughout the course of your transplant experience such as pre-operative care, waiting on the list, the transplant procedure itself, post-operative recovery and potential complications.

In addition to written manuals, we offer Patient Education Classes throughout the course of your transplant process. Your earliest classes will deal with both pre and post operative concerns such as how to recognize and handle the potential complications of liver disease, what to expect from the actual surgery and your post-operative recovery. We highly recommend that your immediate family members (or other individuals who may be helping you) attend with you. Immediately after your transplant, classes are held daily on the post transplant unit. Most classes are run by the Clinical Transplant Coordinators, although a few are run by nutritionists, pharmacists and social workers. Periodically, we also hold evening seminars on various disease topics and all patients are kept informed of these through the mail.

Our Patient Education Video Program is an additional source of education for our post-transplant patients. This is a channel on the hospital TV system that includes 200 interactive educational videos, many of which are specific to transplant, and is free of charge. Both doctors and nurses will use this system to help you understand what to expect during your stay in the hospital.