The Swedish Liver Center and Liver Transplant Team work closely with patients to evaluate and assess patients with chronic liver disease to help determine if a liver transplant is the best option. Pretransplant tests will be administered to help determine if a liver transplant is the best option and to increase the likelihood of success.
Evaluation of patients for transplantation is the result of a coordinated process which looks at the whole patient. A preliminary consultation can be obtained either at the center or in a regional liver clinic. Patients with decompensated liver disease may undergo a complete Swedish inpatient transplant evaluation while being managed for complications of liver disease.
Evaluation is conducted in stages and is customized to efficiently address key issues that might preclude transplantation in a particular patient. After the evaluation is completed, patients are discussed in the multidisciplinary selection committee A complete presentation is made and opinions welcomed from all participants in the program. Decisions about candidacy are made by consensus.
The comprehensive transplant evaluation seeks to determine the ability of the patient to benefit from transplantation and to enjoy a successful outcome with long-term good health.
Requirements for Liver Transplant Candidacy
Progressive, potentially fatal liver disorder or suffers from a complication directly related to a liver disorder that substantially impairs the quality of life and daily function, and for which all alternative medical and surgical treatments short of liver transplantation have been exhausted or would be less effective.
Liver disease is not expected to recur and cause disability within five years.
Patient is not terminally ill and the liver transplant is likely to prolong life for at least five years restoring the patient to a range of physical and social function suitable for the activities of daily living.
Patient does not have involvement of a major system (e.g., cardiovascular or neurologic) that would preclude surgery or indicate a poor potential for rehabilitation.
Patient’s psychological assessment, social arrangement and family support indicate reasonable expectation that the patient will adhere strictly to the difficult long-term medical regimen that will be required post-transplant.
Patient has no active alcohol or substance abuse problems and has signed a contract, has completed a period of documented sobriety from alcohol and unprescribed narcotics and illicit drugs, and has psychosocial clearance.
Patient has a diagnosis meeting criteria for liver transplant, severity of illness meeting minimum listing criteria, and does not have any absolute contraindication.
The patient undergoes a comprehensive assessment which is reviewed by the multidisciplinary transplantation committee.
Who can not get a liver transplant
Some patients may not be eligible for transplant if they are unlikely to survive the procedure or receive long term benefit.
Following are some medical conditions that would disqualify a candidate for a liver transplant:
Non-Liver cancer (extrahepatic malignancy) where patients do not meet standard oncologic criteria for cure (e.g., stage 1 breast cancer greater than fiver years post treatment).
Some primary liver cancers
Sepsis unresponsive to treatment
Current substance abuse
Coma with evidence of irreversible brain injury
Severe and non-treatable heart and /or lung disease limiting safety of the operation
Alcoholics in recovery and other prior substance abusers who have documented abstinence and have undergone a thorough multidisciplinary assessment (including social and psychiatric evaluation) may be considered for liver transplantation if they possess appropriate psychosocial support systems so that they can comply with life-long immunosuppressive therapy and be expected to maintain permanent abstinence from all addictive substances.
IV drug abusers must be drug free prior to listing. All substance abusers must sign a contract and submit to periodic, random drug screening.
Waiting for a Transplant
Getting a liver transplant can be a long process. It can take months or even years before a compatible donor liver is found. Once you have been selected as a candidate for a liver transplant your name is added to a national waiting list. This list is ranked by how sick potential recipient’s are. Very sick patients are higher on the list than people who don’t need a transplant right away.
You will receive instructions on how to stay in contact with the Swedish Transplant Team. The Transplant team maintains your status on the waiting list. If your liver disease worsens or another health problem develops your status on the wait list could change.