What is a liver transplant evaluation?

People who have a diseased liver may consider transplantation as a treatment option. A transplant evaluation is necessary to determine the risks and benefits of transplantation for each individual, identify potential problems, discuss the options of a living donor transplant, and identify risks for the potential donor.

Much of your transplant-related care will be handled by a transplant hepatologist—a medical physician with expertise in liver disease and management of patients with cirrhosis awaiting liver transplantation. Additional consultation with a cardiologist for people with heart disease, a pulmonologist for patients with lung problems, a nephrologist for candidates with kidney problems, and an endocrinologist for patients with diabetes may be ordered as needed.

The evaluation for transplantation usually takes place on an outpatient basis but may occur when you are an inpatient in urgent circumstances. During the evaluation you will have a number of medical tests:

• Blood tests to determine your blood type, liver and kidney function, and viruses to which you may have been exposed in the past, such as hepatitis A, B, and C and HIV

• A chest x-ray to see if your lungs are healthy

• A Doppler ultrasound and/or MRI of the liver, which enables the physician to see your liver and the flow of blood through the arteries and veins

• Tuberculosis testing, called a PPD skin test

• An electrocardiogram (ECG)

You may also be asked to undergo additional tests such as a colonoscopy, upper endoscopy, echocardiogram, cardiac stress test, and lung function tests.

If you are being evaluated for liver transplantation, you will see a number of healthcare professionals who can assess these issues:

• A transplant surgeon will discuss the operation.

• A social worker will help you identify some of the issues you are facing and talk with you about your ability to handle the responsibilities that come with being a transplant recipient.

• An infectious disease doctor will identify any active or potential issues with infection.

• A psychiatrist, along with the social worker, will help you identify and handle troubling issues such as depression.

• A financial coordinator, along with the social worker, will help you understand insurance issues about liver transplant.

• A nutritionist will help you plan a diet that will keep you in the best possible health.

You will also meet with a transplant nurse coordinator. The coordinator is an important person in your care— he or she acts as a liaison between you and the other healthcare providers. You can view the coordinator as a resource for information at all points along your path to transplantation.

After your transplant evaluation is complete, the transplant team reviews all the information gathered in this process.

The team may make recommendations for other necessary tests and vaccinations. Ultimately, the team members decide whether it is the appropriate time to list you for liver transplantation, whether there are outstanding issues that need attention, or whether you are not a candidate for transplantation. A member of the transplant team will see you at a follow-up appointment in the office to discuss this decision and its impact on your future health care.