Before Liver Transplant
The decision to perform a liver transplant depends on a variety of factors. These include patients’ overall health, the severity of their liver condition, the availability of suitable donor livers, and patient preferences and treatment goals. Our liver experts partner with patients and their families to choose the most appropriate treatment.
Time is critical to people waiting for liver transplants. One of the strengths of our Liver Transplant Program is that we spend an average of less than nine weeks conducting comprehensive pre-transplantation evaluations on prospective transplant recipients – and we offer an expedited transfer and evaluation process for patients with both acute liver failure and acute-on-chronic liver failure.
Our evaluation to determine eligibility for the transplant includes tests to find compatible donors as well as an overall health assessment.
Tests can include:
- Compatibility tests: Blood typing, tissue typing, and crossmatching to match patients with a liver
- Comprehensive blood tests: To check heart, kidney, liver, thyroid, and immune system
- Imaging: Depending on the patient’s situation, this can include chest X-ray, abdominal ultrasound, computed tomography (CT) scan of chest or abdomen, and bone density scans
- Pulmonary tests: Including arterial blood gas tests and pulmonary function tests
- Colonoscopy: For certain patients, depending on age and medical history
- Mammogram and pap smear: For certain female patients, depending on age and medical history
Candidates for liver transplant must have:
- No absolute contraindication to liver transplantation
- No alternative form of therapy
- A willingness and ability to accept liver transplantation, comply with follow-up care, and cover the costs of transplant surgery and post-transplant care
To help prospective transplant recipients make the most educated decisions about their care, we ensure that they fully understand the proposed course of treatment. We review the reasons and potential risks and benefits of the procedures, evaluations, and studies that patients will likely undergo during the transplant process.
If our team believes that a liver transplant is the best treatment option for a patient – and he or she wishes to pursue this option – the patient’s name is added to the national United Network for Organ Sharing (UNOS) waitlist.
The liver transplant waitlist is a computer list maintained by UNOS, which coordinates efforts among donor hospitals and transplant centers nationwide to allocate donated organs for transplantation.
The waiting time varies, depending upon organ availability and the severity of the patient’s illness. During the waiting period, patients are seen in the UT Southwestern Transplant Clinic and will need to have regular lab work to maintain their position on the waitlist. Transplant surgery usually occurs within six to 12 hours of initial contact.
There is no way to know when a donor liver will become available. Once patients are placed on the waitlist, they need to be available by phone at all times. It’s critical that patients contact their transplant team with any changes in phone numbers, addresses, or insurance coverage.
It’s also important that patients keep the transplant team updated about their overall health after they have been accepted as transplant candidates. If patients develop a serious infection or their health otherwise worsens, they should ask their doctor to notify the transplant office because we might need to upgrade their priority on the waitlist. Patients also should notify us if they are admitted to another hospital.
Prioritization and Allocation
To ensure that all patients in need of a liver transplant have equitable access to available donor organs, we use patient-evaluation tools developed by the UNOS/Organ Procurement and Transplantation Network, which prioritize and allocate donor livers to the patients who need them most.
These evidence-based guidelines take into account factors such as blood-clotting time and levels of bilirubin, creatinine, and sodium. They also help us assess the relative disease severity and risk of death in every patient with end-stage liver disease.
Unlike other transplanted organs, livers are matched only for blood type and size. They don’t require special tissue-typing to determine which liver donor makes the best match.
Because the waiting period can be stressful, we invite patients and families to take part in a support group led by one of our transplant social workers. We offer patients and families a caring environment in which to share experiences, coping strategies, and information related to liver transplantation. The group is open to patients being evaluated for liver transplantation, those waiting for transplant, and those who have received liver transplants.