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Adult Liver Transplant Frequently Asked Questions
How is a patient's care coordinated between his/her doctor and Ronald Reagan UCLA Medical Center?
The patient's physician will refer him/her to the Dumont-UCLA Liver Transplant Program to determine candidacy for a liver transplant. Usually, the physician will call one of the UCLA transplant physicians to discuss the patient's medical history. If the patient is a potential candidate, an evaluation appointment will be requested.
What happens at the evaluation appointment?
Most evaluations are conducted on an outpatient basis over two or three days. During this time, the patient will meet with a social worker, transplant hepatologist, surgeon, transplant coordinator, psychiatrist and dietitian, as well as other specialists as needed. The evaluation is customized to each patient's medical condition. Once the evaluation is complete, each patient's case will be presented at the weekly meeting of the UCLA Liver Transplant Consultation Team. This group includes specialists from surgery, adult and pediatric hepatology, cardiology, pulmonary, nephrology, hematology, infectious disease, psychiatry, as well as transplant coordinators and social workers. At this time, a determination will be made if any other tests are required to ensure the patient's candidacy for transplant. The patient and referring physician will be notified of the recommendation made by the transplant team.
What are the options for transplantation?
Today, the only option available for adults requiring liver transplantation is a cadaveric donor. In order to receive a donor organ, each potential recipient must be on the national transplant list, which is maintained by the United Network for Organ Sharing (UNOS). More than 9,000 potential recipients are currently awaiting liver transplantation. When a donor liver becomes available, UNOS identifies the best possible match and notifies the UCLA Transplant Center. The number of patients awaiting transplantation far exceeds the number of donor livers available. In order to increase the number of suitable organs, UCLA is undertaking an exciting new approach to liver transplantation. Some donor livers are suitable to "split," enabling two recipients to receive a transplant from one donor liver. At the time of the patient's evaluation, it will be determined if he/she is a candidate for a split liver graft. Results at UCLA have determined that split liver transplantation is a viable option for many transplant recipients. While on the waiting list, each patient's health status is followed closely. Close contact among the patient and family, the patient's physician and the UCLA coordinators is essential. Any hospitalizations, surgeries, tests, infections or change in address and phone number should be reported to the UCLA transplant coordinator so records are up-to-date if a liver becomes available. Each patient needs to schedule an appointment with his/her UCLA transplant coordinator every six months while on the waiting list.
Who will coordinate the patient's care at UCLA?
During all phases of the transplant experience, the UCLA clinical nurse coordinator is the primary contact person. Patients meet their preoperative transplant coordinator during the evaluation appointment. Once hospitalized for transplantation, the inhouse liver transplant coordinator will answer questions and coordinate the care. Upon discharge from the hospital, an outpatient case manager will assume responsibility for coordinating care. In addition, a liver transplant coordinator is on-call 24 ours a day should any emergencies arise.
What preparation is needed for transplantation?
While waiting for a donor liver, it is extremely important to maintain contact with the preoperative transplant coordinator. Changes in the patient's medical condition may affect his.her status on the transplant waiting list. Planning ahead for after surgery should be done at this time as well. Provisions for child care, transportation needs and assistance after transplant need to be in place prior to surgery. In addition, many patients find it helpful to attend support group meetings with other transplant patients. The UCLA social worker can assist in locating a group geared toward individual needs.
How long is the hospitalization following transplantation?
Most liver transplant patients can expect to be in the hospital anywhere from 12 to 30 days. Plans for discharge from the hospital begin once the patient has been transferred from the intensive care unit to the surgical transplant ward. The inhouse transplant coordinator is responsible for the organization of all additional services that will be required to help in the transition from hospital to home. In addition, the coordinator will teach the patient and family about medications and after-transplant care.
Who will take care of the patient's health needs after leaving the hospital?
The first month after discharge, all medical care will be coordinated by the UCLA outpatient case manager. An outpatient case manager and a surgeon will see the patient weekly in the outpatient clinic. If the patient's condition remains stable, clinic visits will be reduced to every two weeks. At this time, visits will be alternated between the primary physician and UCLA. The frequency of clinic visits at UCLA will decrease as long as the liver is functioning well.