What Are The Liver Transplant Eligibility Requirements?
Liver transplant, also called hepatic transplant, refers to the surgical removal of your entire liver. It can help save your life when your liver no longer functions. It is then substituted with all or part of a healthy donor liver. This could come from a living or a deceased donor.
The liver is a vital organ that filters your blood and eradicates harmful toxins from your body. Liver transplant is usually the last treatment alternative for people with chronic liver diseases and sudden onset of liver disorders. Do you require a liver transplant? Are you satisfying the liver transplant eligibility requirements? How do the waiting lists work? If you’re looking for answers to such questions, please read the blog.
Liver Transplant Survival Statistics
A study suggests that the one-year survival rate of liver transplants is 89%, and the five-year survival rate is about 75%. In some cases, the transplanted liver may fail or the original disease may recur.
For this reason, it becomes essential that the doctor checks your recovery long after the transplant to identify any problems. You will have frequent blood tests. You may also have to take anti-rejection medications for your whole life.
When Is A Liver Transplant Done?
Research says that about 8000 liver transplant surgeries are done every year in the United States.
Doctors may recommend a liver transplant for people with end-stage liver disease who can die without this surgery. Doctors may also recommend a liver case when all other treatment alternatives aren’t enough to keep a person alive.
Liver transplants are generally an option for those with long-term (chronic) liver disease or if liver failure happens very quickly in life. One of the most common reasons for adults to receive a liver transplant is cirrhosis, which replaces healthy liver tissues which scarred tissues. Some common causes of liver cirrhosis are:
- Alcohol abuse
- Nonalcoholic fatty liver disease
- Autoimmune hepatitis
- Chronic hepatitis B or chronic hepatitis C
- Metabolic disorders
- Biliary atresia, a liver disease that occurs in newborns
Before considering a liver transplant, the healthcare provider will evaluate whether the surgery will be effective and extend a person’s life. A person may not be an ideal candidate for a liver transplant if they have other chronic ailments that might impact a transplant’s success.
Examples include a person who has cancer that has extended to other body parts or has acute heart concerns. Another example will be if a person has cirrhosis from alcoholism, their ability to stop drinking is assessed as part of the transplant planning.
Liver Transplant Team
Your liver transplant team consists of a group of specialists who will help you every step of the way. They include the following:
- A hepatologist, a liver specialist
- A transplant surgeon
- A transplant coordinator, usually a nurse who has expertise in the care of liver transplant patients. This person will be your prime contact with the transplant team.
- A social worker to talk about your support group of family and friends, employment, and financial requirements
- A psychiatrist to help you cope with challenges that may come in conjunction with a transplant, including anxiety and depression
- A chemical dependency expert to help if you have a history of drug abuse or alcoholism
- An anesthesiologist
- A financial counselor to act as a mediator for you and your insurance provider
Are You Eligible For A Liver Transplant?
Some people even after getting diagnosed with chronic liver disease aren’t a good candidate for the liver transplant surgery. Do you know why? You may have heard doctors saying that a person doesn’t satisfy the liver transplant eligibility requirements. So, what is the eligibility criteria for obtaining a liver transplant?
You will be required to undergo an evaluation process to find out if you are satisfying the liver transplant eligibility requirement. This evaluation will help your transplant team to know more about you and your condition. It will also provide you with an opportunity to learn more about your transplant team and the transplantation process.
The evaluation process will:
- Confirm your diagnosis and check the severity of your liver injury or disease
- Evaluate other physical or psychological problems that might be responsible for your symptoms
- Provide you information regarding the benefits and risks of transplantation
- Assess your financial benefits and talk over the financial considerations significantly correlated with a transplant.
- Answer any queries you and your family members may have.
Required Tests Before Getting A Liver Transplant:
Bring all your medical records, liver biopsy slides, X-rays, and the list of your medicines in your assessment for a liver transplant. The team may also order the following tests to know if you are meeting the liver transplant eligibility requirement:
- CT scan, which uses X-rays and a computer to generate pictures of your liver. CT scans and chest X-rays will also monitor your heart and lungs.
- Echocardiogram to evaluate your heart
- Doppler ultrasound to determine whether the blood vessels to and from your liver are open
- Pulmonary function tests to know how appropriately your lungs exchange oxygen and carbon dioxide
- Blood tests to discover more about your blood and to determine how well your liver is functioning. You will also be examined for HIV, hepatitis, and other viruses (including herpes and Epstein-Barr).
How Does The Liver Transplant Waiting List Work?
When you satisfy the condition for a transplant but don't have any doctor lined up, your name will be put under a waiting list by the healthcare center. Patients are listed based on their blood type, body size, and medical condition. Each patient is assigned a priority score depending upon the results of three blood tests (including bilirubin, creatinine, and INR). This score is collectively termed as a model of end-stage liver disease (MELD) in adults and pediatric end-stage liver disease (PELD) in children.
Patients who have the highest scores and severe liver failure acquire top priority for a transplant. If their condition becomes worse, their scores further rise, and their priority goes up. In this manner, the transplants go to people who require them the most.
It's difficult to say for how long you may have to wait to get a transplant. Your transplant coordinator will always be there to discuss where you are on the waiting list.
What Are The Types Of Liver Transplant?
You can obtain a liver either from a deceased donor or a living donor.
- Deceased Donor Liver Transplant: Liver is obtained from patients who are brain dead. Brain-dead patients are actually dying from a clinical, legal, spiritual, and ethical point of view. Once a brain dead patient is found, who is deemed as a prospective donor, the doctor tries to maintain the blood supply in his or her body artificially. This is the key principle behind deceased organ donation. Patients who die of a brain hemorrhage, head trauma, or other conditions that lead to sudden death are the most suitable candidates for organ donation.
- Living Donor Liver Transplant: The liver possesses the ability to regenerate if a part of a standard healthy liver is removed. So we can divide part of the liver from a live donor and place it into another patient. In a live donor liver transplant, a part of the liver is surgically eradicated from a living donor and transplanted into a recipient soon after the recipient’s liver has been completely removed.
Donor safety is the chief objective of the entire process. Ultimate care is taken while choosing and operating live donors. The odds of serious morbidities after a living donor liver removal is about 10%. The chances of death in the donor is 0.02 - 0.5%. Live donor liver transplantation is feasible because the liver has the capability to regrow to its original size. The regeneration of the liver after surgery is completed within 4 - 8 weeks.
Who Can Be A Liver Transplant Donor?
A living donor can be a spouse, a relative, a friend, or an unrelated person with a willingness to donate. They will undergo complete medical and psychological assessments to mitigate risks as much as possible. Blood type and body size are significant to find a match. A donor younger than 60 years old is suitable.
Hospitals will evaluate possible donors for liver disorders or other things, including:
- Overuse of alcohol or drugs
- Liver disease
Positive Aspects Of Living Donation
- Organ donation can save the life of a transplant candidate.
- Many donors have reported a positive emotional experience as they have saved the life of a dying person.
- Overall health and quality of the recipient improve. They are allowed to resume their regular activities with greater ease.
- Transplant candidates are more benefited when they receive organs from a living donor in contrast to organs from deceased donors.
- The risk of organ rejection is less when the donor belongs to the same family.
- A living donor can schedule the transplant at a time that’s convenient for both the donor and the transplant candidate.
What Happens During A Liver Transplant Operation?
A liver transplant surgery generally takes 6 - 12 hours. The surgeons will remove your liver and replace it with a donor's liver. A liver transplant is a major surgery, and so the doctors will implant some tubes in your body. These tubes will help your body perform certain functions during the operation and also a couple of days afterward.
Are There Any Risks?
Rejection and infection are the two biggest risks associated with liver transplants. Rejection happens when your body’s immune system attacks the new liver as an unwanted foreign substance; in a similar manner as it would attack a virus. To avoid rejection, doctors prescribe certain drugs to suppress your immune system.
What Medicines Do You Need To Take?
Your doctor may recommend you take the following medications:
- Anti-rejection drugs
- Antifungal cream to minimize the risk of fungal infections
- Other medicines that your doctor prescribes depending upon your symptoms
After A Liver Transplant
After a liver transplant, you will have frequent follow-up visits during 1 - 2 years after the transplant. You will also be required to make some lifestyle changes to reduce the risk of infections.
Follow up Care:
Your first follow-up care will most probably be after 1 - 2 weeks after you leave the hospital. You will meet your transplant surgeon and coordinator. A member of the psychiatric team or social worker will also be there. After this appointment, your next follow-ups will be 3, 6, 9, and 12 months after the transplantation and then once a year for the rest of your life.
Following are some of the best tips you can consider for maintaining good liver health:
- Have a healthy, balanced diet. Limit sugar, salt, fat, and cholesterol. A nutritionist or dietician will provide you a meal plan based on your health requirements.
- Don’t eat unpasteurized milk products or meat, fish, or raw eggs.
- Quit smoking.
- Don’t consume alcohol if you have a history of alcohol use disorder.
- Be physically active.
- Avoid contact with the things that might carry germs, including soil, ticks, rodents, mosquitoes, birds, reptiles, and water from rivers or lakes.
- If you are planning to travel to a different country, ask your care team how you can lower your risk of infection.