Becoming a Liver Recipient

The majority of livers that are transplanted come from organ donors who have died (cadaveric transplant). These organ donors are adults or children who have become critically ill (often due to an accidental injury) and have died as a result of their illness. If the donor is an adult, he or she may have agreed to become an organ donor, or a spouse/relative agreed to donate a loved one’s organs. Donors can come from any part of the United States and complete a thorough screening process prior to donation. 

Someone receiving a transplant may either get a whole liver or a segment of one. If an adult liver is available and an appropriate match for two individuals on the waiting list, the donor liver can be divided into two segments and each part transplanted. This kind of transplant is done more often in children than adults.

Liver allocation

The United Network for Organ Sharing (UNOS) is responsible for transplant organ distribution in the United States. UNOS oversees the allocation of many different types of transplants, including liver, kidney, pancreas, heart, lung, and cornea.

UNOS receives data from hospitals and medical centers throughout the country regarding adults and children who need organ transplants. The medical team is responsible for sending the data to UNOS and updating it as a patient's condition changes.

Guidelines have been developed to ensure that all people on the waiting list are judged fairly as to the severity of their illness and the urgency of receiving a transplant. Once UNOS receives data from local hospitals, people waiting for a transplant are placed on a waiting list and given a "status" code. In general, livers are matched based on the severity of the recipient's liver disease, which is measured using the Model for End Stage Liver Disease (MELD) score. The people in most urgent need of a transplant are placed highest on the status list and given first priority when a donor liver becomes available.

Recipient selection process

1. When a donor organ becomes available, a computer searches all the people on the waiting list for a liver and sets aside those who are not good matches for the available liver.
2. A new list is made from the remaining candidates.
3. The person at the top of the new list is considered for the transplant. If, for whatever reason, he or she is not a good candidate, the next person is considered, and so forth.
4. Sometimes, people lower on the list might be considered before a person at the top because of the size of the donor organ or the geographic distance between the donor and the recipient.

Transplant waiting list

A complete evaluation must be done before an individual can be placed on the transplant wait list. The evaluation includes an appointment with each member of the transplant team. The members of our team include the hepatologist, transplant surgeon, transplant psychologist, transplant coordinators, dietitian, pharmacist, social worker, and financial coordinator. A series of consultations along with lab work, X-rays, and additional testing will be completed in order to determine the patient's ability to receive a liver transplant.

Transplant wait list testing includes:

• Psychological and social evaluation
  Includes the assessment of family and social support. We will evaluate your commitment to transplant and your previous compliance with medical treatment and appointments, identifying any barriers that may interfere with care of your new organ. Examples: Taking medications as recommended on time, arriving on time for all appointments, and reliable transportation.
• Diagnostic blood tests
  Includes blood type testing. Blood tests are done to gather information to help determine how urgent it is for an individual to be placed on the transplant list. It also ensures the individual receives a donor organ that is a good match.
• Diagnostic tests
  These tests include, but are not limited to, ultrasounds, X-rays, cardiac testing, CT scan, lung studies, and colonoscopies. 

Ready for transplant

There is no definite answer to how long a person will have to wait for a liver to become available. Some individuals may wait only days, while others wait longer depending on how sick they are and the availability of the right match as determined by UNOS.

Our transplant team has its own specific guidelines regarding waiting on the transplant list and being notified when a donor organ is available. In most instances, recipients will be notified by phone or pager that an organ is available. They will be told to come to the hospital immediately to be prepared for the transplant.

Life after transplant

Living with a transplant is a lifelong process. For the rest of an organ recipient's life, he or she must take medications to fight the body's natural response to reject a transplanted organ. Other medications must be taken to prevent infection and side-effects which can be caused by the anti-rejection medications. Frequent visits and contact with the transplant team are essential to maintaining health and quality of life for organ recipients.