Liver Transplant (cont.)
How Does the Waiting List Work?
If you become an active liver-transplant candidate, your name will be placed on a waiting list. Patients are listed according to blood type, body size and medical condition (how ill they are). Each patient is given a priority score based on three simple blood tests (creatine, bilirubin, and INR). The score is known as the MELD (model of end stage liver disease) score in adults and PELD (pediatric end stage liver disease) in children.
Patients with the highest scores are transplanted first. As they become more ill, their scores will increase and therefore their priority for transplant increases, allowing for the sickest patients to be transplanted first. A small group of patients who are critically ill from acute liver disease have the highest priority on the waiting list.
It is impossible to predict how long a patient will wait for a liver to become available. Your transplant coordinator is always available to discuss where you are on the waiting list.
Where Does a Liver for a Transplant Come From?
There are two types of liver transplantation options: living donor transplantation and cadaveric transplantation.
Living donor
Living donor liver transplants are an option for some patients with end-stage liver disease. This involves removing a segment of liver from a healthy living donor and implanting it into a recipient. Both the donor and recipient liver segments will grow to normal size in a few weeks.
The donor, who may be a blood relative, spouse or friend, will have extensive medical and psychological evaluations to ensure the lowest possible risk. Blood type and body size are critical factors in determining who is an appropriate donor.
Recipients for the living donor transplantation must be active on the transplant waiting list. Their health must also be stable enough to undergo transplantation with excellent chances of success.
Cadaver
In cadaveric liver transplantation, the donor may be a victim of an accident or head injury. The donors heart is still beating, but the brain has stopped functioning. Such a person is considered legally dead, because his or her brain has permanently and irreversibly stopped working. The heart continues to beat because the donor is attached to a respirator. The respirator delivers an adequate supply of oxygen to all vital organs. At this point, the donor is in an intensive-care unit.
The identity of a cadaveric donor and circumstances surrounding the person's death are kept confidential.
Screening
Hospitals will evaluate all potential donors for evidence of liver disease, alcohol or drug abuse, cancer or infection. Donors will also be tested for hepatitis, AIDS and other infections. If this screening does not reveal problems with the liver, donors and recipients are matched according to blood type and body size. Age, race, and sex are not considered.
The transplant team will discuss your transplantation options with you at the time of your pre-transplant evaluation, or you can contact the transplant team for more information.
Next: What happens when they find a match? »
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