Recipient Evaluation and Preparation

What is the preparation required for transplant?

Patients initially might not believe that they need a transplant; they may deny their sickness, expect it to be very easy, feel guilty or be anxious or depressed about the process or costs involved. While most patients have these feelings, it is important to keep the larger picture in mind, seek support from family members, and prepare for the transplant without losing precious time.

The preparation starts with recipient’s evaluation. Once the patient is found suitable for transplantation, potential donors in the family should have their blood group checked, and one who is compatible should undergo donor evaluation. If the donor is suitable, authorization committee clearance is obtained, and the transplant is scheduled. Patients planned for a living donor transplant can generally undergo the same in 2-3 weeks

If a suitable family donor is not available, after the recipient evaluation is found satisfactory, the patient is registered on the waiting list for a deceased donor liver transplant.

Patients should make adequate arrangements for blood products and finances well in advance. This will ensure a hassle free experience at the hospital. While preparing for a transplant, all doubts should be clarified and understood. Patients and the donors are encouraged to meet other patients and families who have undergone the operation and are willing to share their experiences.

Pre-transplant recipient (patient) evaluation

Once ESLD (End Stage Liver Disease) is diagnosed, and the need for a transplant is perceived, patients undergo a formal evaluation, which involves blood tests, CT and other scans, tests for heart, lungs, and other organ systems, and assessments by various specialists. Evaluation is performed with the following goals:

  • To establish the diagnosis, and find the cause of cirrhosis/ESLD
  • To determine the severity of liver disease and its effect on other organ systems such as kidneys, lungs, etc and thus determine urgency of transplant
  • To detect the presence of a liver tumour, if any
  • To evaluate the condition of other organ systems, such as the heart, lungs, kidney, etc and determine the patient’s ability to tolerate this major operation
  • To evaluate difficulty, technical feasibility, and risk of surgery (previous abdominal infections, surgery, and thrombosis of liver blood vessels must be taken into consideration)

Evaluation generally takes about 7-10 days and is carried out on an outpatient basis. The evaluation period may be very hectic and stressful. Patients are advised to relax between tests and follow the instructions for each test carefully for accurate results. The pre-transplant coordinator is the main contact person during evaluation, and will fix appointments for any tests or procedures. At every stage of evaluation, the plan for further tests may change depending on patient reports. Therefore it is important to visit the pre-transplant clinic routinely for review by the transplant team.

Patients who are sick may be advised to undergo evaluation in the hospital. If unexpected problems are detected such as cardiac disease, thyroid disease, infection, etc. they have to be treated before transplant. Patients with other co-existing diseases, such as uncontrolled blood pressure, diabetes or untreated cardiac problems might have to wait until they are corrected.

Liver transplant can even be performed after successful cardiac angioplasty or heart bypass surgery.

Related links:

Donor Evaluation and Preparation
Approaching the Transplant
Post-transplant Care

References:
www.medanta.org
http://www.bhf.org.uk/
www.unos.org