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By Mayo Clinic staff
Being placed on the waiting list
If you have chronic liver failure, your doctor may refer you to a transplant center to undergo evaluation for liver transplant. The transplant center conducts a wide variety of tests and procedures to determine whether to place your name on the national waiting list for a new liver.
Tests, procedures and consultations you may undergo include:
- Laboratory tests, including blood and urine tests to assess the health of your organs, including your liver
- Imaging tests, such as an ultrasound of your liver
- Heart tests to determine the health of your cardiovascular system
- A general health exam, including routine cancer screening tests to evaluate your overall health
- Psychological evaluation to determine whether you fully understand the risks of a liver transplant
- Meetings with social workers who assess your support network to determine whether you have friends or family to help care for you after transplant
- Addiction counseling to help people with alcohol, drug or tobacco addictions to quit
- Financial counseling to help you understand the cost of a transplant and post-transplant care, and to determine what costs are covered by insurance
Once these tests and consultations are completed, the transplant center's selection committee meets to discuss your case. It determines whether a liver transplant is the best treatment for you and whether you're healthy enough to undergo a transplant. If the answer to both questions is yes, then you're placed on the transplant waiting list.
Determining your position on the waiting list
Doctors use results of liver function tests and other factors to determine your prognosis and your place on the transplant waiting list. Your prognosis is sometimes called your Model for End-Stage Liver Disease (MELD) score. The higher your MELD score, the more dire your situation. People with higher MELD scores generally are offered donor livers first. MELD scores range from 6 to 40.
Waiting for a new liver
Your wait for a donor liver could be days or it could be months. Or a donor liver that's a good match for you might not become available.
As you wait for a new liver, your doctor will treat the complications of your liver failure, to make you as comfortable as possible. Complications of end-stage liver failure are serious, and you may be frequently hospitalized. If your liver deteriorates, your MELD score is updated.
Living liver donors
A small percentage of liver transplants are completed each year using a portion of a liver from a living donor. If you have a family member or friend who is willing to donate part of his or her liver to you, talk to your transplant team about this option. Not all transplant centers are able to do living-donor transplants.
Living-donor transplants have good results, just like transplants using livers from deceased donors. But fewer living transplants are performed because of restrictions on the donor's age, size and health that make finding a good match difficult. The surgery carries significant risks for the donor. Your transplant team can discuss the risks with you and the potential donor.
- Rudow DL, et al. Critical care management of the liver transplant recipient. Critical Care Nursing Quarterly. 2008;31:232.
- Liver transplant. American Liver Foundation. http://www.liverfoundation.org/education/info/transplant/. Accessed Oct. 21, 2008.
- What I need to know about liver transplantation. National Institute of Diabetes and Digestive and Kidney Diseases. http://digestive.nddk.nih.gov/ddiseases/pubs/livertransplant_ez/. Accessed Oct. 21, 2008.
- Koffron A, et al. Liver transplantation: Indications, pretransplant evaluation, surgery, and posttransplant complications. The Medical Clinics of North America. 2008;92:861.
- Arora G, et al. Management of chronic liver failure until liver transplantation. The Medical Clinics of North America. 2008;92:839.
- Brown RS. Live donors in liver transplantation. Gastroenterology. 2008;134:1802.
- O'Leary JG, et al. Indications for liver transplant. Gastroenterology. 2008;134:1764.
- Removal reasons by year. Organ Procurement and Transplantation Network. http://www.optn.org/data/. Accessed Oct. 23, 2008.
- Transplants by donor type. Organ Procurement and Transplantation Network. http://www.optn.org/data/. Accessed Oct. 23, 2008.
- Liver Kaplan-Meier patient survival rates for transplants performed: 1997-2004. Organ Procurement and Transplantation Network. http://www.optn.org/data/. Accessed Oct. 23, 2008.
