Before Your Liver Transplant

Pre-Liver Transplant Evaluation and Testing

When you choose to come to UPMC for a liver transplant, the evaluation process will begin before you even travel to Pittsburgh. At UPMC, you'll have a team of experts working with you. We’ll guide you through each step of the liver transplant process, from pre-liver transplant evaluation to recovery and lifestyle planning.

To determine your candidacy for liver transplant evaluation, the transplant team will:

• Review your medical history
• Verify your health insurance benefits

If you clear these steps, we’ll schedule your pre-liver transplant assessment. This may take up to one month.

The Liver Transplant Team

Your liver transplant team at UPMC will help you with all aspects of liver transplant, including the:

• Physical
• Mental
• Financial
• Social

Your pre-liver transplant assessment will last one week. You will need to bring a caregiver or support person with you to each appointment.

During your weeklong visit, the transplant team will conduct diagnostic tests, blood work, and multiple consultations to decide if a liver transplant is right for you.

If you don't live near Pittsburgh, Family House offers affordable lodging for transplant patients and their caregivers. Family House is not a medical facility.

Your liver transplant team will mail you a binder packet letting you know where your scheduled appointments and tests will take place. This packet will also provide you with details about the liver transplant evaluation process.

Along with your liver transplant coordinator, your care liver transplant team includes:

• Transplant hepatologist will examine you, perform a medical history and physical, and will focus on the signs and symptoms of your liver disease. He or she may also review other options for managing your liver disease
• Liver transplant surgeons will assess your physical capability and risks for transplant. He or she will review your liver disease and the medical management of your diagnosis and address all treatment options available to see if liver transplant is the best option for you.
• Liver transplant nurse coordinator will introduce you to the transplant process and review your evaluation schedule. The visit will consist of preliminary health screening, medicine review, and an overview of the transplant process. Your transplant nurse coordinator is here to answer any questions you may have.
• Living-donor transplant nurse coordinator will answer any questions you may have about living donation and the transplant waitlist process.
• Nutritionists will assess your nutritional status, dietary knowledge, and provide education and recommendations for your diet.
• Pharmacists will meet with you to get a complete list of all your medicines and supplements you take, both prescription and over the counter and ask you how you take your medicines.
• Social workers will discuss your support team at home, your prescription insurance coverage, and other social parts of the transplant process. You will also learn about fundraising options.
• Behavioral health nurses or psychiatrists will assist you and your family in coping with the stresses associated with chronic disease and the transplant process. He or she will also assess any current psychiatric/mental health symptoms that are being treated, or may need to be treated.
• Credit analysts will review your insurance coverage and benefits information. He or she will help you to understand your insurance policy and will be your point of contact for insurance changes. They will also explain any parts of the liver transplant process that insurance does not cover and suggest options to assist with those costs.

Pre-Liver Transplant Evaluation and Tests

The outpatient transplant evaluation can take up to a week to complete. You are required to bring a caregiver with you to each appointment. This person must meet with the transplant team and understand his or her role before, during, and after your liver transplant.

During your pre-liver transplant assessment, you might have these clinical tests:

• Imaging scans
• Blood Tests
• Radiology
• Diagnostic tests
• Consults and exams

Pre-liver transplant tests

To prepare for certain tests, we may ask you to not eat or take some medicines before coming to the hospital. Any of those additional requirements for your pre-liver transplant evaluation will be on your schedule in the binder mailed to you.

Your care team will give you instructions before each test and consultation.

Liver transplant tests include:

• Magnetic resonance imaging (MRI) of abdomen/pelvis OR
• Computed tomography (CT) scan of abdomen/pelvis
• Dobutamine stress echocardiogram (DSE)
• Ultrasound of abdomen/pelvis
• Electrocardiogram/chest X-ray
• Colonoscopy
• Mammogram or Pap smear for women
• Other testing and blood work

These tests will provide comprehensive data for the transplant team to assess the function of your liver and other body systems to determine if you are a candidate for transplant.

Whenever possible, the transplant team will look for other ways to treat your liver disease and void performing a liver transplant too early.

You may also need to go to counseling or rehab for alcohol, depending on the cause of your liver failure.

Liver Transplant Waiting List

If you're a candidate for liver transplant, we will place you on the UNOS (United Network for Organ Sharing) waiting list. Prior to being placed on the waiting list, your insurance company has to provide approval. You will be notified regarding the outcome by phone and mail.

If it is determined you are not a candidate for transplant at this time, you may be asked to return for additional testing to be cleared medically to be placed on the waiting list.

Your blood type and your MELD (Model for End-Stage Liver Disease) score decide your position on the liver transplant wait list.

The MELD score is a series of blood tests that measure how your liver works. The higher your score, the higher you will be on the list.

Your UPMC liver transplant team will continue to manage your liver disease while you wait for an organ with your local medical team.

Learn more about the liver transplant waiting list.

Liver Transplant Candidates Staying Close to Pittsburgh Treatment Centers

While on the liver transplant wait list, you need to live within 4 to 6 hour travel radius of UPMC so you can get to the hospital when we find a liver donor match.

You will need to get blood tests periodically to recertify your MELD score and be seen in the clinic at least every 6 months so the team can assess your readiness for transplant.

Most patients continue to see their primary hepatologist for follow-up care during this waiting time. Your doctor will remain in contact with the transplant team at UPMC during this time in addition to your regularly scheduled visits at UPMC.

If you don't live near Pittsburgh, please find a way to move closer. Family House an affordable "home away from home" for liver transplant patients and their families. This is not a medical facility.