UNIVERSITY HOSPITAL OF CINCINNATI
 
Liver Transplant: Am I Candidate?

Before being placed on transplant waiting lists for an organ match can happen, it will be necessary to determine if you are a candidate. The individualized evaluation is a series of tests and consultations on an outpatient basis. On a case by case review, your results will be evaluated with you and the physicians to determine your eligibility.

Thinking About A Liver Transplant

A liver transplant can be a positive life changing surgery. The decision to start the process of determining if you are a candidate should be taken seriously. Besides determinig your candidacy, it is important to condsider the emotional, physical and financial aspects of a transplant.

Before starting the process, ask yourself some of these questions:

  1. Do I have choices beside a transplant?
  2. What are the benefits and risks of a transplant?
  3. What are the survival rates for liver transplants?
  4. How much will a liver transplant cost?
  5. Do I have a support system of family and friends to help me through the transplant? (Family/friends)

If you feel comfortable in your decision to move forward in the transplant process, here is what you can expect when you are evaluated for liver transplant candidacy at the University Hospital.

The Liver Transplant Evaluation Process

There are several evaluations to determine your overall physical health. The evaluation period may take approximately two to four weeks. Each of the following evaluations are required:

Nutritional Evaluation

Our transplant dietician will review the results of several blood tests that measure proteins in your blood along with the results of other tests. The dietician will also discuss your diet with you. (Although there are no specific foods that benefit the liver, the quality of your diet is important.) An optimal dietary plan will be determined based on your height, weight and blood results.

Dental Evaluation

It is required to have a recent x-ray of your teeth so infection can be ruled out. If you are planning on any major dental work, it must be completed and healed before you can be placed on the transplant waiting list. A letter from your dentist will need to be provided stating that all necessary dental work is complete.

A Friendly General Dental Care Reminder:
Remember to brush and floss your teeth daily. Visit your dentist for a thourough examination every 6 months to keeps your teeth and gums in good condition, both before and after the transplant.

Are You Over 50?

According to the American Cancer Society guidelines, all patients over 50 must be checked for cancer lesions. To be sure the colon (the lower bowels) are cancer free, a barium enema or a colonoscopy is necessary.

Additionally, men over the age of 50 will require a testicular and prostate examination by your family physician. A PSA (Prostate Specific Antigen) test will also be necessary to start the series of blood tests.

Women over the age of 50 will need a gynecological (Gyn) evaluation, even if you have had a hysterectomy. In addition to the complete gynecological examine a current Pap smear, (current is considered within the past one to three years), is necessary. These evaluations can be conducted by your private gynecologist. For any female patients over the age of 40, current mammograms, within the last year, are also needed for your evaluation records.

Cardiology Physician Evaluation

If you have a history of heart disease, diabetes or abnormal cardiac tests, you will need to see a cardiologist after an EKG and/or echocardiogram is completed. Stress tests, an arteriogram and other tests may also be ordered to evaluate your heart. The results of these tests will allow the cardiologist to determine if your heart is healthy enough to withstand the transplant operation.

Pulmonary Physician Evaluation

If you have an abnormal pulmonary function tests or a history of lung disease, you will need to see a pulmonologist.

A Word About Smoking:
Smoking will increase your risk of lung infection, including pneumonia, after transplant. You must stop smoking and using any tobacco products before having a transplant.

Hematology Physician Evaluation

Hematologists are experts in disorders of the blood and clotting systems. You may or may not require a consultation with a hematologist depending on your blood clotting patterns.

Nephrology Physician Evaluation

A consultation with a nephrologist, a kidney specialist, will be necessary if you have decreased kidney functioning.


The Evaluations Are Complete, What's Next?

After the necessary testing and the evaluations have been completed, the Multi-Displinary Liver Transplant Team will discuss your case at length and determine the best approach. In some cases, continued medical management will be recommended. In other cases, transplant will be the best option.

If transplant is your best option, your case will be sent to the Ohio Solid Organ Transplant Consortium (OSOTC). This statewide organization is supported by the transplant centers in Ohio. This organization guarantees uniformed patient selection guidelines and equal access for all transplant candidates. Patients on the waiting lists at Ohio transplant centers have priority to donors in the state of Ohio or in our region depending on the medical condition.

Once approval for transplant has been given by both Multi-Displinary Liver Transplant Team and the OSOTC, insurance coverage is verfied and your name will be place on the National Waiting List.

It is not uncommon for you to wait for a transplant for several months. It is important for you to keep in the best physical and emotional condition possible during this time.

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Required Testing For
Liver Transplant Consideration

There are several tests that are required to determine your overall physical health. Based on the results of these test, further recomendations or evaluations may be necessary. The common tests are as follows:

Blood Tests

Blood tests are done to help us evaluate your nutritional status and the condition of your heart, liver, blood, kidneys and other organs. These tests will help determine your previous contact to common viruses such as hepatitis, chicken pox and mononucleosis. You will be asked to sign a consent form for the HIV virus.

Urine Tests

Urine tests will evaluate the functioning of your kidneys.

Electrocardiogram (EKG)

An EKG will be conducted to evaluate your heart. If your heart shows any abnormalities or if you already have an exisiting history of heart problems, you will see a cardiologist.

Chest X-Ray

A chest x-ray will help evaluate the condidtion of your lungs.

Pulmonary Function Test (PFT)

Pulmonary function tests are breathing tests that measure the health and capacity of your lungs. This test is completed by a blood draw. If you have a history of smoking or lung disease, a PFT is especially important.

Magnetic Resonance Imaging (MRI)

Magnetic Resonance Imaging is a techniques that allows physicians to see inside the human body without entering the body. The MRI will show any lesions in the liver, the blood vessel sizes around the liver and your liver size.

Abdominal Ultrasound with Doppler

The Doppler ultrasound uses sound waves to show the size, shape and exact position of your liver. It also shows the blood vessels to and from the liver.

Esophago Gastroduodenoscopy (EDG)

A small lighted tube is passed through the mouth, down the esophagus and to the stomach to explore any abnormalities.

The Five Steps of Organ Matching:

1. An Organ Is Donated

When an organ becomes available, the Organ Procurement Organization (OPO) managing the donor enters the medical information about the donor into the UNOS computer system.

2. A List Of Potential Recipients Is Generated

The UNOS computer system generates a list of candidates who have medical and biologic profiles compatible with the donor's. The computer ranks candidates based upon how closely they match the donor's medical urgency, time spent waiting and proximity of candidates to the donor.

3. The Transplant Center Is Notified Of Available Organ

Organ placement specialist at the OPO or the UNOS Organ Center contact the transplant centers whose patients appear on the ranked list.

4. The Transplant Team Considers the Organ for the Patient

When the team is offered an organ, it bases it's acceptance or refusal of the organ upon established medical criteria and organ condition, candidate condition, staff and patient availabilityand organ transportation. By policy, the transplant team has one hour to make its decision.

The Organ is
Accepted or Declined

If the organ is not accepted, the OPO continues to offer it for patients at other centers until it is placed.

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