Video/Liver transplant evaluation

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Video/Liver transplant evaluation

Also View: Waiting For an Organ Transplant View Video At J & F Blog

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Evaluation@ Methodist Hospital .

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Liver Transplant Evaluation and Waiting List

,Patients who may require liver transplant are usually referred to us by their primary doctor. The primary doctor is often but not always a gastroenterologist (GI specialist). Patients may also be self-referred if they have no primary doctor, in which case they will first be evaluated by a team member to determine if a full liver transplant evaluation is necessary.The first step in evaluation is an initial assessment by a doctor or nurse practitioner in the group. The doctor may be either a liver transplant surgeon or hepatologist (liver disease specialist). At the first visit, the doctor may recommend that a full evaluation for liver transplant be performed. A full evaluation is scheduled by our coordinating team to accommodate specific patient needs.Evaluation for liver transplant always includes the following:Education program(which

must be attended by both the patient and a family member or companion who will serve as the patient's health care proxy)Consultation with a transplant surgeon, hepatologist, transplant coordinator, social worker, financial counselorLaboratory testsCT or MRI of the abdomenUltrasound of the heart (echocardiogram)EKGChest XRayPulmonary function testsPPD (to determine exposure to tuberculosis)Routine recommended health screening (mammogram, colonoscopy, PAP smear, in selected individuals)Chest CT scan and Bone Scan (in cancer patients)Evaluation may also include the following:Consultation with a transplant psychiatrist, family medicine doctor, cardiologist, pulmonary specialist, infectious disease specialist, nephrologist (kidney doctor)Stress TestCardiac CatheterizationHead CT scanAngiogramLiver biopsyAfter evaluation is completed, the patient's case will be discussed at a

selection meeting attended by all team members to review the findings of the evaluation. One of three outcomes from the selection meeting will apply to each patient, who will be considered:Suitable for listing for transplantationPossibly suitable but requiring more work upNot suitable for transplant.Patients will be notified of their status after selection by mail and direct communication with the team. In the event the patient is not considered a qualified candidate for liver transplant, alternative treatments will be recommended.If the patient is found to be suitable for transplant, he/she will be registered on the waiting list for liver transplant through UNOS (United Network for Organ Sharing).Potential reasons patients may not be candidates for transplant include the following:Recent or active substance abuse (alcohol or illegally obtained

drugs)Advanced or uncontrollable medical condition (cardiac disease, pulmonary disease, psychiatric disorder, infection, etc.) that would make transplant recovery difficult or dangerous.Primary liver cancer beyond Stage I or IIMetastatic cancer to the liverRecent or active cancer outside the liverInadequate social support/family assistanceUndocumented immigration status in the U.S. (note that in certain cases legal visitors to the U.S. may be able to receive organ transplants)Waiting Time for Liver TransplantationAll patients registered on the UNOS waiting list must wait for a compatible donor liver. The waiting time is dependent on several factors, including the blood type of the patient, the cause of the liver disease (acute or chronic), severity of illness of the patient,

size/weight of the patient, and certain diseases that influence waiting time, such as liver cancer.Most patients with liver disease have a chronic condition leading to cirrhosis. Severity of illness in cirrhosis is calculated by blood tests that measure the serum bilirubin, creatinine, and blood clotting time (INR). The resulting score is called the MELD score. Higher MELD scores are associated with more severe illness. Patients with low MELD scores (less than 15) may not require transplantation in the near future, but may remain on the waiting list. Patients with higher MELD scores have greater need for an immediate transplant and are therefore higher on the waiting list.Some patients with low MELD scores may therefore wait for liver transplantation for many months or even years if they are stable, while other patients with high MELD scores may wait only

days if they are critically ill. http://www.montefiore.org/services/liver-transplant-patient-evaluation/

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