When a compatible liver donor is found, you will be notified by a member of the liver transplant team. At that time, you will be given instructions about coming to the hospital for your transplant. We advise you not to bring any valuables with you, such as jewelry, money, or expensive clothing. We will tell you that we have a potential donor and then ask how you have been feeling physically. If you have a fever, vomiting or diarrhea, we may not be able to do the transplant. The most important thing you can do while waiting for a transplant is to seek treatment quickly if you become ill, so that you will be ready at any time should a donor liver become available. The first call you get does not always mean the transplant will occur. We will tell you that we have a potential donor. The surgeon examines each donor organ and may find that the organ is not strong and healthy. If the donor organ is not functioning well, we will not do the transplant. This does not happen often, but it is a possibility.

Leaving for the Hospital

You need to go directly to Emory as soon as you have finished talking with the coordinator. If you have difficulty driving to the hospital, please call the coordinator and we will try to help you get there safely. We would not want you to lose a chance for a new liver because your car broke down. If you have arranged to fly, you will need to contact the air ambulance service immediately for departure and arrival times and then tell your coordinator. We can then anticipate when you will arrive at Emory.

Arriving at the Hospital

When you arrive at Emory University Hospital, please drive to the valet entrance on Clifton Road, then go directly to Admissions located on the second (2nd) floor of the hospital. Sign in under the surgeon’s name. The admissions personnel will direct you to your room where you will be prepared for surgery. This time will be very hectic. Several final procedures such as blood tests, chest X- ray and an EKG may need to be done. A transplant surgeon and an anesthesiologist will also talk with you, and you must sign a Consent for Surgical Operation.

Liver Transplant Surgery

On the same day or the next morning, you will be taken to the operating room. There, the anesthesiologist will insert intravenous needles for administration of medications and blood and for taking blood samples. Medications will be given to make you fall asleep. A catheter will be inserted into your bladder and will drain your urine, and a tube that goes into your lungs will be attached to a respirator to breathe for you during surgery and for a short period of time afterwards. The transplant surgeons will make an incision in your abdomen to remove your liver and replace it with your new one. Small tubes known as Jackson Pratt (JP) drains will come out of your incision to drain fluid from around your new liver. They will remain in place until the drainage stops. A nasogastric (NG) tube will be placed through your nose and into your stomach to keep it from filling with air until normal bowel functions return. Your family will be asked to wait for you in the Intensive Care Unit (ICU) waiting area. We will make every effort to keep them informed of your progress. If your family chooses to wait somewhere other than the ICU waiting area, they should inform the ICU nursing staff of their location. The surgery usually lasts from six to eight hours, but may take considerably longer in some patients. When the surgery is over, one of the surgeons will speak with your family. You will be taken directly to the ICU. Your family will be able to visit you for the first time about one hour after your arrival in the ICU. Each time your family members visit, they first will be asked to wash their hands at the sink inside your room. This is required of all visitors at all times. Hand washing is also required of all members of the liver transplant team. As you begin to recuperate and feel stronger, the tubes and catheters will be removed.

Post-Transplant

When you awaken in the ICU, the sights and sounds around you may be unfamiliar. Your recovery will be monitored and managed by highly skilled critical care nurses.

The tube in your lungs will remain in place to help you breathe deeply and prevent pneumonia until the anesthesia is completely out of your system. Because this tube passes through your vocal cords, you will not be able to talk while it is in, which will make communicating a challenge. The nurse will ask you “yes” and “no” questions and help you write messages on a notepad. When the tube is removed, you will be asked to do exercises, such as coughing and deep breathing, to keep your lungs clear.

You will have “squeezing devices” or sequential compression devices on your legs to promote the circulation of blood in your legs while you are on bed rest. This helps to prevent the formation of blood clots in your legs.

You will probably look different to your family: you will be pale, possibly swollen and will feel cool to their touch. This will improve after just a

few hours in the intensive care unit. You will also still be sleepy and may not remember the first time your family visits.

A typical stay in the ICU is one to four days. Several times each day, various members of the transplant team will make rounds to monitor your progress. Please do not be alarmed at all of the attention you will be getting. This is normal and necessary for a safe recovery.

You will then be transferred to the surgical floor where our nurses and physical therapists will help you regain your strength, teach you how to care for yourself when you go home, and prepare you for discharge from the hospital. If all goes well, you can expect to spend five to seven days on the surgical floor before your discharge. During your recovery you will have both “good” and “not-so-good” days, but over time, you should get stronger and begin noticing differences in your body and abilities. Keep in mind that no two liver transplant patients recover at the same pace. You are an individual and comparing your progress with that of another transplant patient may only confuse and frustrate you. As you move closer to the time you will leave the hospital, your activity level will be increased. You will be encouraged to walk daily. Eventually, you will be able to venture outside the hospital. You will also be expected to know how and when to take your medications.

Deep Breathing and Coughing

Deep breathing and coughing will help expand your lungs and remove lung secretions that have settled during your surgery. A respiratory therapist will show you how to use an incentive spirometer, a device that will help you take deep breaths. It is a good idea to take the incentive spirometer home with you to use the first four to six weeks after surgery.

Coughing may be painful, since you will have an incision. The nurse will teach you how to splint (decrease the pain by holding a pillow or your hands over your incision). Ask the nurse for pain medicine so you can breathe deeply and cough more easily and effectively.

Exercise and Activity

You should begin to increase your physical activity soon after your surgery. A physical therapist will be available to you. Once you are feeling better, generally the third or fourth day after surgery, you should begin walking in your room and the hallway. Each day increase the time and distance you walk.