Liver Transplant Surgery

Getting Started: The Initial Consultation and Evaluation Period

At the initial consultation, you will meet with a transplant surgeon, transplant coordinator, and social worker to review your medical and social history. After the initial consultation, the evaluation period begins, which includes a battery of tests. It is important for you to understand that there are many tests required to ensure that you need, and are eligible for, liver transplantation.

Testing for Transplantation

Blood Tests: Your blood type will be confirmed and you will have routine chemistry, hematology, coagulation, hepatitis screens, and viral studies performed. You will also be asked to consent to an HIV test, a requirement of all potential transplant recipients.

Radiology:

You may be required to have one or more of the following tests:

  • Chest x-ray: to rule out any pulmonary and lower respiratory tract disease processes.
  • Ultrasound: to examine your abdominal organs and blood vessels.
  • CAT Scan (Computerized Tomography): to make a computer image that shows the size and shape of your organs and major blood vessels. A contrast material will be injected into a vein to enhance the quality of the Image.
  • Magnetic Resonance Imaging (MRI): to show more detail of your abdominal organs and their blood vessels.
  • GI Series/Barium Enema: to determine if there are any tumors, ulcers, or other abnormalities present in your digestive tract.
  • VCUG (Voiding Cysto-Urethrogram): to determine if your bladder is functioning properly. This is a particularly important test if you are diabetic and have been unable to produce urine.

Cardiac Work-Up:

This may be required to determine if your heart is strong enough to undergo a transplant operation and includes:

  • ECG: examines how well your heart is beating and conducting.
  • Echocardiogram: a test that uses sound waves to look at your heart's pumping ability.
  • Stress Test: examines your heart's response to exercise. There are a few different types of stress tests, some of which require you to walk on a treadmill and some of which give you medicine to make your heart behave as if you are exercising. Your transplant team will decide which is appropriate for you.
  • Cardiac Angiogram: If you have an abnormal stress test, your doctor may require that you undergo an angiogram. Dye will be injected into your arteries, which will help identify any abnormalities or blockages in the blood supply to your heart.

Pulmonary Work-Up:

If you are/were a smoker or have a lung disease, the following tests may be necessary and repeated throughout the course of your workup:

  • PFTs (Pulmonary Function Tests): to check lung capacity and function, and to determine your blood's ability to carry oxygen.
  • ABG (Arterial Blood Gas): to test carbon dioxide and oxygen levels. This test requires a small amount of blood to be drawn from an artery for further analysis.

Social Work/Psychiatry:

A consultation is necessary to help you and your family with the many psychological and social issues involved with transplantation. It is vital that all potential transplant recipients have adequate support systems in place to help them throughout the entire process.

Living Donor Work-Up:

If your transplant surgeon has suggested living-donation as an option for you, your transplant coordinator will initiate this process with you and your family.

Alcohol/Drug Screening:

All potential transplant recipients may be randomly tested for alcohol and illicit drugs at any time during the transplant process. Current use of any of these substances will forfeit a patient's eligibility to be transplanted at our institution.

Financial Concerns: Insurance coverage for transplantation will be verified at the time of your initial consultation. Many insurance companies require a letter from a physician confirming the medical necessity for a transplant. The results of your evaluation may also be required prior to approval.

Pharmaceutical Expenses:

Potential transplant candidates are required to sign an agreement to claim all responsibility for prescription expenses not covered by insurance since the medications are very expensive. If your pharmacy plan does not cover transplant medications, our financial counselor and transplant social worker will do their best to help you attain sufficient coverage.

Completing Your Evaluation

Based on the results of your evaluation, the Transplant Team will determine first, if a transplant is necessary and second, if you are physically able to undergo the procedure. These results will be sent to you by mail.

Approved candidates will be placed on the United Network for Organ Sharing (UNOS) and NYU Medical Center transplant waiting list, or will begin the process for living-donor transplantation.