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If You Qualify as a Liver Transplant Candidate After you have completed the required evaluations and tests, your case may be presented at the Liver Transplant Multidisciplinary Team Conference. Team members will discuss your case and determine whether you should continue to be treated by medical management, if further evaluation is necessary or if a transplant or some other intervention is the best option for you. If it is obvious that you are too early for transplantation or if you have major medical problems that indicate you should not have surgery, your case may not be presented to the full committee. If a transplant is the best option for you, a summary of your case will be sent to the Ohio Solid Organ Transplant Consortium. Ohio Solid Organ Transplant Consortium (OSOTC) OSOTC is a state wide organization supported by the transplant centers in Ohio. This organization ensures uniform patient selection guidelines, which are applied across all transplant centers. This is to assure 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 their medical condition. A complete description of your medical, occupational and psychological status is submitted to the Consortium, along with a description of your family support and ability to follow doctor's orders. You are identified by initials only and the summary is reviewed by a committee. Approval is necessary in order to proceed. Once the Liver Transplant Multidisciplinary Team Conference and the Ohio Solid Organ Transplant Consortium have given approval, and we have confirmation of coverage from your insurance company, your name will be placed on the waiting list. The transplant coordinator will contact both you and your doctor. It is not uncommon for you to wait on the transplant list for several months. It is important for you to keep in the best physical condition possible during this time. To track your medical status, you will have periodic appointments with the transplant hepatologist and occasionally the surgeons. It is important to see your family physician at least once a month. When you are accepted as a transplant candidate, you will be listed on the national computerized waiting list. Our local organ procurement agency is the LifeCenter. The LifeCenter is a member of the United Network for Organ Sharing (UNOS). UNOS is a non-profit organization, regulated by the federal government to assure equal access for all patients needing cadaver organs for transplantation. Through a computer link-up, potential recipients throughout the United States are identified for each donor organ. You will be listed according to your blood type and body size. Your medical condition will affect your rank on the list, as will the length of time you are on the list. Because of these factors, the list is always changing. Therefore, the coordinator has no way of knowing where you stand on the list nor can it be accurately predicted when you will receive a transplant. Emotional aspects of waiting
Many patients find it helpful to attend the liver transplant support group meetings during this time of waiting. Meetings are held at least every two months, and notices are sent out before each meeting. You and your family are invited to attend these meetings. If you have children, now is the time to plan ahead for their care during and after your hospitalization. Your children, depending on their age and health status, may come to visit you in the hospital once you are on 6 West, but must be carefully supervised and have no contagious diseases. Visits must be cleared with the nursing personnel the day before the visits are to occur. Taking care of yourself It is important to improve your overall health through physical conditioning. Now is the time to begin the habit of regular exercise. Walking is excellent exercise. If you experience any discomfort, shortness of breath or chest pain, stop and rest, and promptly discuss these symptoms with your doctor. If you are unable to walk, try simple leg exercises while sitting or lying in bed. For example, while lying bed with your legs straight, bend or flex your feet toward your head or rotate each foot in circles. Exercises such as these will help improve blood flow and strengthen muscles. It is also important to avoid all tobacco products, to never drink alcoholic beverages and to limit your use of pain medications including Tylenol, aspirin, Motrin and other over-the-counter medications. Nutrition is also an important factor while waiting for your transplant. A well-balanced diet of fruits, vegetables, breads, cereals and meats should be followed. Intake of fatty foods should be limited. For certain types of liver diseases, there are dietary restrictions. Consult your physician if this applies to you. If your nutrition is compromised due to your liver disease, tube feeding may be an alternative. While you are waiting for a liver transplant Be aware that your survival and recovery following transplant depends heavily on your state of health prior to the surgery. It is your responsibility to:
The transplant team will decide which medications you will need prior to transplant. Listed below are brief descriptions of some of these medications. Oral anti-fungal agents Depending upon your status on the list, you will need to take a medicine that will prevent fungal infection in your mouth, esophagus, stomach and intestines. Also, depending on your status, you will be given a prescription for clotrimazole (Mycelex) troches or nystatin swish and swallow. It is very important to take this medication every day while waiting on the list for a transplant. Do not let your supply run out, even for a couple of days. You will continue taking antifungal medicine for three months after your transplant. Hepatitis Vaccine Blood tests to determine the presence of Hepatitis B will be required. If these tests are negative, you will receive a vaccine to prevent Hepatitis B in your new liver. Three injections, 30 days apart, are needed to complete the vaccination series. You will get the first injection during the work-up time period. You will need to receive the second injection 30 days later and the third injection five (5) months after the first one. These injections can be received at the University Medical Arts Building or at your local doctor's office. Blood tests will also be conducted to determine exposure to Hepatitis A. If this test is negative a vaccine will be given to prevent Hepatitis A. This vaccine is given in a serious of two injections, the second given six months after the first. Pneumococcal Vaccine The pneumococcal vaccine prevents pneumococcal pneumonia and is important because your immune system may be weak after your transplant. This injection will be given during your work-up, either at the University Medical Arts Building or at your doctor's office. Tetanus Toxoid Vaccine The tetanus toxoid vaccine prevents tetanus infections. The Public Health Service recommends that all persons be vaccinated at least once every 10 years. Contact your doctor if you have not had this vaccine within the past 10 years. Flu Vaccine It is important that you receive the current year's flu vaccine, provided you are not allergic to eggs. Items to consider prior to transplant Compliance Labs (blood work) Before your transplant labs will be drawn at least every 3 months. Depending on the severity of your illness, labs may be required more frequently. After your transplant, labs will be drawn twice a week immediately following the transplant. Over the next year lab draws are typically reduced to once a month depending upon how well you do after transplant. Lab draws will be required every month, or every two months, for the rest of your life. Medications Before your transplant, you will be required to take at least one medication and possibly others depending on your diagnosis. After your transplant, you will need to take several different medications and will be taking some of these medications for the rest of your life. If you have an alcohol and/or drug-related disease You will have random urine screens for drugs and alcohol both prior to transplant and after transplant. If you are found to be using alcohol and/or drugs prior to your transplant, you may be removed from the list. You will also be required to participate in at least 3 months of documented rehabilitation. Rehabilitation documents must be turned in to the Medical Social Worker to be placed in your chart. Narcotics Anonymous or Alcoholics Anonymous meetings will be required. Your Medical Social Worker will advise you about a substance abuse program that is appropriate for you. Insurance Please review your insurance to determine if you have the following coverage:
If you do not understand your insurance coverage, please contact the financial counselor here at The University Hospital through the Transplant Office. Equipment You must be able to accurately use the following items to assess blood pressure, weight and temperature on a daily basis.
Pagers When you are placed on the transplant waiting list, you will receive a pager so we can reach you quickly if a liver becomes available. You will need to provide us with the phone numbers of relatives, neighbors and places you commonly visit. If you live in a small town, notify the police or county sheriff's office regarding your situation and let us now their names and phone numbers. Pagers are available free of charge. When you are activated on the UNOS waiting list, you can obtain a pager through a national program called Life Page at 1-800-326-8638. The transplant office is responsible for initially contacting Life Page. Life Page will locate a paging company closest to you that will provide you with a pager. To keep this service available for all who need it, you will be expected to return the pager as soon as you receive a transplant and to pay for the pager if it is lost.
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We understand that the wait for a liver transplant can be long and stressful. Do not hesitate to discuss your feelings with your religious counselor, pastor, a social worker, psychologist or a friend. Talking with someone may help put your concerns in perspective and relieve the stress and frustration of the situation.
Your compliance before and after transplant can determine how well you recover. Being compliant includes taking all of your medications as prescribed, having laboratory studies done as ordered, watching your dietary intake, exercising and returning to the clinic for post-transplant follow-up. 