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What are the criteria for getting placed on the liver transplant waiting list?
The criteria to be on the liver transplant waiting list are:
Have acute or chronic liver failure. Acute liver failure is when you get very sick very fast from liver failure. Chronic liver failure develops over time and usually happens because you have cirrhosis.Have cholangiocarcinoma or hepatocellular carcinoma. You may be eligible for a liver transplant if you have other kinds of cancer. But there are specific eligibility criteria for each cancer type.Have cancer that spread to your liver like metastatic colorectal cancer or gastrointestinal neuroendocrine tumors.Be well enough to have surgery.Don’t have substance use disorders or be considered at risk of these disorders.
If your healthcare provider recommends an organ transplant for you, they’ll refer you to a transplant hospital. The transplant center’s multidisciplinary team will evaluate you to decide if you’re a suitable candidate.
Each transplant hospital has its own criteria for accepting candidates for organ transplantation. If they accept you as a candidate, they’ll put you on the national waiting list maintained by United Network for Organ Sharing (UNOS). They’ll let you know when you join the waiting list.
The list ranks prospective recipients by need. For example, if you have acute liver failure, meaning you got very sick very fast, you’ll be at the top of the list.
If you’re like most people, you have chronic liver failure and/or liver cancer. In that case, the UNOS will use a scoring system called MELD (Model for End-Stage Liver Disease) or PELD (Pediatric End-Stage Liver Disease). The scoring system uses information about your liver and blood test results to determine your place on the waiting list.
How are donors matched with transplant recipients?
To be a match for a donor liver, you’ll need to:
Have the same or compatible blood type as the potential donor.Be about the same height and weight as the potential donor so that the donor liver is large enough to meet your body’s needs.
What happens when you’re matched with a donor liver?
If there’s a match, your transplant coordinator will call you with instructions about what you need to do right away. For example, they’ll tell you not to eat or drink anything so that you’ll be ready to receive anesthesia just before your surgery.
They’ll tell you to get to the transplant hospital right away. The transplant surgery team will start surgery as soon as possible after the donor liver arrives at the transplant hospital. When you arrive at the transplant hospital, you’ll:
Have standard health screening tests to confirm you’re still able to go through surgery. For example, you may have an electrocardiogram (EKG) to check your heart rhythm and a complete blood count (CBC) to confirm you don’t have an infection.Meet with your surgeon and anesthesiologist to prepare for surgery.
What happens during a liver transplant?
Liver transplant surgery is a major operation. You’ll receive general anesthesia so you’re asleep during the surgery. Your surgeons will place a variety of tubes in your body to carry out certain functions during and right after your surgery. You’ll have:
An IV (intravenous catheter) in a vein of your arm or hand to deliver fluids and medicine.An IV in a vein of your neck or thigh so providers can take blood samples and continuously check your blood pressure.A tube through your mouth and into your windpipe that connects to a mechanical ventilator. The ventilator will expand your lungs mechanically to make sure you keep breathing during surgery.Tubes in your abdomen to drain blood and fluid from around your liver.A nasogastric tube that your providers will insert through your nose to your stomach. The tube will drain fluid from your stomach.A catheter in your bladder to drain urine.
To begin the operation, your surgeon will:
Make one long incision across your abdomen to reach your liver.Carefully separate your liver from the ligament that connects to your abdominal wall.Place a clamp on your bile ducts and the blood vessels that are connected to your liver.Remove your liver and gallbladder.Put the donor liver in place.Attach it to your blood vessels and bile ducts.Close your incision.
How long is liver transplant surgery?
Your surgery may take up to 12 hours. If you have friends or family waiting at the hospital, a member of your care team will check in with them throughout your surgery.
How much of a donated liver is needed for a liver transplant?
That depends on the type of donation. If you receive a liver from a deceased donor, you receive the entire liver.
In living donor transplantation, most adults only need one liver lobe (hemisphere) from a living donor. If the donated lobe is healthy, it’ll regenerate to its former size. Surgeons often select the right lobe for transplant because it’s a bit bigger, but in a pinch, the left lobe will do fine, too.
What happens after liver transplant surgery?
You may remain in intensive care for several days following your surgery. You’ll have a nasogastric tube, and you’ll get nutrition from an IV line until your body can process liquids and solid food.
Your healthcare team will monitor your condition and watch for signs of complications. They’ll take blood samples to check how your new liver is working. They may need to manage issues like:
Blood sugar levels.Blood volume.Electrolyte levels.Fluid levels.
When tests show your new liver is working and your vital signs are stable, your providers will remove the IV tubes from your neck and nasogastric tube.
You’ll move from intensive care to another area in the hospital where you’ll stay for one to three weeks as your body continues to recover.
Next, your bowels will start working again, meaning you can pass gas or poop. You’ll begin drinking liquids. Your care team will start providing small amounts of solid food. They’ll begin reducing the amount of pain medication you receive via IV.
Before you go home, your team will show you:
How to care for your surgical wound.How to take your medications, like the immunosuppressants you’ll take to reduce the chance your body will attack the donor liver.How to check your own blood pressure and pulse.How to recognize signs of infection.When it’s important to contact them.
What kind of follow-up care will I have during recovery?
As you continue to recover at home, you’ll have frequent checkups with your healthcare team. They’ll do blood tests to check your liver’s health.
