Preparing for Your Visit
Jefferson's Liver Transplant Program has a supportive staff to help guide patients through the process of liver transplantation – from initial evaluation to transplantation and postoperative care. This page provides a high-level overview of what you can expect.
Initial Evaluation, Education and Consent
Step 1: Evaluation by Hepatologist
The first step is to be referred to one of the Jefferson hepatologists (liver specialists). A hepatologist reviews each patient's medical history and previous diagnostic tests and procedures and then examines and interviews the patient. From there, the hepatologist will determine if there are any alternative treatments for the patient and, if not, if the timing is right to refer the patient for a transplant evaluation.
Step 2: Preapproval for Transplant Evaluation
There are several steps that must be completed before a patient can be evaluated by Jefferson's Liver Transplant Program. First, the patient's referring physician(s) sends medical information to the transplant office. Meanwhile, the Liver Transplant Program's financial coordinator contacts the patient's payer(s) to ensure Jefferson has the necessary authorizations before the evaluation.
Once the financial coordinator has obtained the necessary authorization, a Liver Transplant Program social worker (a professional who evaluates readiness for transplantation and helps support your psychosocial needs) reaches out to the patient to set up the first appointment.
Step 3: Education and Consent for Transplant Evaluation
Patients should plan to spend about half a day for the education and consent process. At this appointment, patients meet with a variety of professionals from the Liver Transplant Program and spend an hour with a social worker.
That session is followed by a two-hour education and consent session with a transplant coordinator (a nurse who serves as the patient's point of contact throughout the process). During this session, patients receive a thorough overview of liver disease, as well as an overview of Jefferson's Program and personnel.
The transplant coordinator also reviews the in-depth Consent for Evaluation for Liver Transplant, which patients must understand and sign before they can proceed with a transplant evaluation.
Finally, the transplant coordinator outlines the medical tests and consultations that must be performed as part of the evaluation process.
Step 4: Evaluation for Liver Transplant
After completion of the first three steps, a pretransplant coordinator will reach out to the patient to introduce him- or herself and to reiterate the tests and consultations that must be completed as part of the transplant evaluation process. Each patient's requirements vary depending on his or her condition and/or circumstances. The testing and consultations typically take two or three days to complete.
Toward the end of the transplant evaluation process, the patient views a presentation about the Model for End-Stage Liver Disease (MELD) system, as well as the process for listing patients and allocating organs in our region and across the United States.
Once all of the testing and consultations are complete, the Liver Transplant Program's multidisciplinary committee reviews the patient's case to determine that no other treatment options are available and that the patient has no contraindications (such as heart disease or lung disease). Following that review and approval, the patient is listed for a liver.
Getting Listed and Staying Ready
Step 5: Being Listed
If approved for a transplant, the patient receives a phone call from the transplant coordinator, as well as a written letter in the mail confirming placement on the United Network for Organ Sharing (UNOS) transplant list. At this time, we will also provide instructions for what to do next.
Step 6: Staying Ready
Whether they wait years or are fortunate to be matched earlier, patients have an important role to play in the transplantation process. During the wait, it is critically important that patients:
- Provide blood samples on a monthly basis for the Jefferson tissue-typing lab
- Keep all studies up to date, as indicated in the instructions we provide
- Keep us informed of any health changes; these changes (such as recently diagnosed conditions or other surgeries) can affect a patient's ability to receive a transplant
- Ensure that we always have the latest insurance information so that we can stay on top of any changes in the financial situation
- Contact us with any changes to phone numbers and/or address; just as important, patients must leave their phones on around the clock so they can be reached if and when a potential organ becomes available
If we can't reach a patient, if tests or blood work aren't up to date or if insurance coverage has changed, it could mean the difference between receiving an organ – and continuing to wait.
Transplantation and Ongoing Follow-Up
Step 7: Transplantation
Once a suitable organ is identified, the patient undergoes the actual transplantation surgery. Some patients receive a few hours of notice; in other cases, patients must drop everything and head to the Emergency Room right away. If the organ is from a live donor, surgery will be scheduled in advance.
Depending on each patient's history and circumstances, liver transplant surgery can take as little as seven or eight hours or as long as 12 to 24 hours. Following surgery, patients typically remain in the hospital for seven to 10 days. Jefferson discharges liver transplant patients only when they are medically and surgically stable. Visiting nurses perform home visits to ensure that patients are monitored and that they're taking medications properly. These nurses also address any questions from patients and their families.
Step 8: Ongoing Follow-Up
The work isn't over after the transplant. We develop a tailored follow-up program for each liver transplant patient. In general, though, patients can expect to be seen in the clinic and have lab work weekly for the first month after the transplant. From there, patients receive follow-up care from transplant hepatologists and surgeons.