Patient Referral Process

Whether through a primary care physician, community gastroenterologist, insurance provider, or some other type of direct referral, the patient is referred to us for evaluation for a possible liver transplant.

When the transplant team has reviewed the patient's entire work-up and determines that the patient should be placed on the transplant waiting list, the next step is to submit the work-up, along with a letter of medical necessity, to the insurance company. The patient's insurance carrier will review the information and either accept or deny the claim.

  • Wait Time
  • Donor-Recipient Match Criteria
  • Guidelines for Patients

Wait Time
The single limiting factor in the number of transplants provided each year to those suffering from end-stage organ failure (whether it is kidney, heart, lung, or liver) is the donor pool. If every potential organ donor (i.e., those who meet donor criteria) would donate an organ, there would be enough for all who are on the waiting list. Unfortunately this is not the case. While there are some 40,000 transplants performed each year, approximately 10-12 people do not get the organ they need in time.

Wait time is dependent upon a number of factors. The time it takes to receive an organ for transplant can vary from a few days to several months, depending on the patient's general condition. The average wait time is typically nine to ten months.

Donor-Recipient Match Criteria
The candidate's match is first based on blood type. If the patient's blood type is "O," he/she must receive a liver or intestinal transplant from a donor of the same blood type. If the patient has blood type "A," he/she should receive a transplant of the same blood type, but in emergencies could receive an organ from an "O" type. Although an "AB" could receive a organ from an "A", "B," or "O" types, all transplants done by crossing ABO blood types carry an increased risk and are reserved for the critically ill.

Another consideration in matching the donor organ to the recipient is the weight range. Based on the patient's physical size and stature and the presence or absence of ascites, the transplant surgeon will assign a weight range to be considered. The donor organ must "fit."

Severity of illness reflects how far end-stage liver disease has progressed. Some candidates are in relatively good condition and can wait for a perfect donor. Many other candidates' physical condition, warrants a timelier transplant, as noted above, and a donor will be selected accordingly.

Length of time on the waiting list also is a component for recipient selection.

Guidelines for Patients
Staying in the best possible condition will ensure the most positive end results for transplantation. Most of these guidelines, such as maintaining a healthy diet, are simple and easy to follow. Here are some basic pointers to keep in mind:

1. Eat small amounts of protein in fish and chicken.
2. Avoid red meat.
3. Eat fresh fruits and vegetables.
4. Avoid canned fruits and vegetables (high sodium content).
5. Supplement your diet with canned nutritional supplements.

Minimal exercise is advised for all patients, and although it may be difficult to do, patients should try to exercise to the extent they are able. Patients with end-stage liver disease will not be able to process nutrients to build muscle. The goal, then, should be to simply maintain current muscle mass.

Mental health is very important. Many patients may feel depressed and require emotional assistance from others. This is absolutely normal and should be expected. Sometimes talking to past transplant recipients helps put the process into perspective and allows the patient to relate to someone who has faced the same issues.

If the patient lives more than one-hour driving distance from the medical center, they should remain close to the hospital for approximately four weeks after discharge. If hotel accommodations need to be made, the staff social worker will be more than happy to help the patient find an affordable place to stay.

Each transplant patient is provided with telephone numbers for emergency situations.