Liver Transplant Evaluation Process

The Emory team is comprised of liver transplant surgeons, transplant hepatologists, and a team of gastroenterologists, anesthesiologists, pathologists, radiologists, psychiatrists, chaplains, nurses, social workers, financial coordinators and pharmacists who are all experienced in treating patients with advanced liver disease. This group is well qualified to perform the sophisticated, life-saving surgical procedures involved in liver transplantation and to provide the care required after surgery.

Before you can be considered a candidate for liver transplantation, a thorough evaluation of your physical and emotional status must be completed on an outpatient basis. Your nurse coordinator and schedulers will arrange this for you. The purpose of this evaluation is to determine just how damaged your liver is and whether liver transplantation is the best treatment option for you. During the evaluation, you and your family may have many questions about the evaluation and what to expect when it is over. Various members of the liver transplant team will be available to answer your questions.

Tests

We will draw blood to determine your blood type and how well your organs are working. Many different tests will be done during the evaluation to determine how damaged your liver is and to determine if there are other physical problems, such as with your heart, kidneys or lungs, which might rule out liver transplant. A urine test tells us if your kidneys are working well and if you are using illicit drugs. The following tests and procedures MAY be done:

• Chest X-ray
• Electrocardiogram (EKG)
• CT or MRI scan
• Doppler ultrasound (looks at blood flow through the vessels to your liver)
• Dobutamine stress echocardiogram or "stress test" (looks at blood flow through the heart and the valves of your heart)
• Endoscopy/Colonoscopy (a tube is inserted through your mouth into your stomach to look for bleeding or into your colon to assess for bleeding or cancer potential)
• Pulmonary function tests (special breathing tests to check your lungs)
• Additional tests or procedures may be ordered by consulting physicians

Upon completion of the evaluation, your case will be discussed by the team members of the Liver Transplant Selection Committee Meeting. The liver transplant team will then determine if liver transplantation is the best treatment option for you. If this is the case, liver transplantation will be discussed with you in more detail.

Meeting the Team

It is important that you meet all the members of the liver transplant team. Each brings special knowledge that will help you during all phases of the transplant process.

These are some of the people you will meet during the evaluation:

Physicians
Numerous physicians will be involved in your care. Emory University Hospital is a teaching hospital. Therefore, in addition to your attending transplant physicians, you will be meeting resident physicians to fellows and consulting physicians from many different services. Multiple specialty physicians may participate in your evaluation, including transplant surgeons, transplant hepatologists (medical liver specialists), gastroenterologists, psychiatrists, hematologists (blood specialists), cardiologists (heart specialists), nephrologists (kidney specialists), pulmonologists (lung specialists), anesthesiologists, and experts in the field of infectious diseases.

Liver Transplant Coordinators
The liver transplant coordinators are Registered Nurses who provide education regarding the transplant and closely help manage patients before and after transplantation. Each patient is assigned a transplant coordinator.

Psychiatry
The psychiatry staff consists of a clinical nurse specialist and a physician who assess the mental health of patients. They will provide and/or help arrange any treatment therapies as needed.

Chaplain
The interfaith transplant chaplain can help you and your family deal with conflicting emotions and difficult spiritual questions.

Pharmacists
The pharmacists are specially trained in transplant care and provide a wide array of information about medications including drug interactions and side effects. The pharmacy staff is an excellent source of drug information.

Dietitians
A dietitian will speak with you about diet recommendations you may need to follow, a healthy body weight for a transplant, and/or changes to your appetite or weight. The dietitian will be available for further nutrition related questions you may have as well.

Social Workers
Clinical social workers play a vital role in assessing your psychological needs, social support, and developing a comprehensive post-transplant plan of care. Your social worker will assist you throughout the phases of your transplant process from pre-liver transplant to post-liver transplant. The transplant social worker is also a viable resource in brokering community recourses, advocating for patient care needs, and providing supportive council and guidance. Your social worker also plays a significant role in the Liver Transplant Selection Committee in assessing if a liver transplant is the best treatment option for you.

Financial Coordinators
A financial coordinator will be assigned to you to help explain your insurance benefits and assist you with any financial issues. The financial coordinator will help you understand the cost of transplantation and your health insurance benefits (see next section). Because this time is stressful, we encourage you to write down your questions so they are all answered before the transplant.