Experts Determine Candidates for a Liver Transplant
The multidisciplinary team at University Hospitals Transplant Institute decides if a patient should be a candidate for a liver transplant after a thorough review of test results, physical examination, medical and social history and doctor recommendations. Decisions about liver transplant candidacy are made by the multidisciplinary team as a group. All decision made by the multidisciplinary team are discussed with the patient by the physician or transplant nurse coordinator. Once accepted for a liver transplant, the patient is placed on the United Network for Organ Sharing (UNOS) liver transplant waiting list.
Liver Transplant Waiting List
While the patient is on the liver transplant waiting list, doctors and the transplant team continue to follow the patient regularly to ensure good medical care and quality of life. Waiting for an organ can be stressful. UH Transplant Institute offers support services for patients and their families that provide assistance during this waiting period.
An individual’s position on the waiting list is determined by a scoring system that ranks the patient’s level of illness. The actual time to transplant can be affected by a number of variables, and may be as short as a few days, to several months or longer, depending on the following factors:
- Blood type
- Body size
- Overall health
- Model for End-Stage Liver Disease (MELD) score
- The availability of a matching liver
Model for End-Stage Liver Disease (MELD) Score
The Model for End-Stage Liver Disease (MELD) is a numerical scale, ranging from 6 (less ill) to 40 (gravely ill), used for liver transplant candidates ages 12 and older. It gives each person a “score” (number) based on how urgently he or she needs a liver transplant within the next three months. The number is calculated by a formula using three routine lab test results:
- Bilirubin, which measures how effectively the liver excretes bile
- INR (prothrombin time), which measures the liver’s ability to make blood clotting factors
- Creatinine, which measures kidney function. (Impaired kidney function is often associated with liver disease.)
A patient’s score may go up or down over time depending on the status of his or her liver disease. Most candidates will have their MELD score assessed a number of times while they are on the waiting list. This will help ensure that donated liver go to the patients in greatest need at that moment.
Patients can be simultaneously listed for a liver transplant at two or more transplant centers. The patient must be evaluated at each center for approval for listing because each transplant center has their own selection criteria. Multiple listing can decrease your waiting time by increasing your potential organ offers.
Receiving the Call
When the transplant surgeon identifies a suitable donor liver for the patient, a transplant nurse coordinator calls the patient to notify them. The patient is then asked to come to University Hospitals Cleveland Medical Center within a time frame to begin preparing for surgery.