The human liver performs very important functions for our bodies. Simply put, the liver removes toxins and other poisons from our blood streams. It also produces proteins for blood plasma, and transforms food into energy. A person cannot survive without a liver. However, the liver is the only organ that does regenerate. This allows for a partial transplant. If you are curious about the process for a liver transplant this is an example of what a patient can expect.
Screening For Transplant Eligibility
Hopefully a family member or friend will be a match and willing to donate part of their liver. It makes the process easier from the standpoint that the patient knows they will receive a liver in time, and the procedure can be planned. If not they will be screened for eligibility.
The team that will perform the evaluation consists of a transplant surgeon, a transplant hepatologist, transplant nurses, a social worker, a psychologist or psychiatrist, and other team members deemed necessary.
First they will perform a psychological and social evaluation. The purpose is to evaluate how well the patient can handle the stress of the procedure and the recovery process. They are also looking at what family support is available and the financial impact to the patient.
Next there is a battery of blood tests that are necessary. The blood tests will help to determine what is needed for a good donor match as well as identify any diseases and other concerns. It also helps to determine the patient’s priority on the transplant list should they be accepted.
Finally there are diagnostic tests. These include x-rays, ultrasounds, liver biopsy, dental exams, and more. The purpose is to determine the overall health of the patient.
Before they put a patient on the transplant list they want to ensure that the transplant has a high likelihood of success. If the patient has a disease or complication that will make it unlikely that the transplant will proceed they will not be put on the transplant list.
Examples of these reasons are recurring infections that cannot be treated, cancer that has spread, cardiac or other medical problems that make it unlikely the patient could survive the transplant, or other serious conditions that will likely not improve after the transplant. If the patient consumes alcohol or does not comply with the treatment regimen they will not be accepted.
Before the Transplant Surgery
If the patient made it onto the transplant list or they are lucky enough to have a partial liver donated, before the surgery their doctor will meet with them.
The doctor will explain the whole procedure in detail and give the patient an opportunity to ask questions. The patient will also need to sign consent forms. It is important that they take the time to read these and understand them.
Depending on the patients situation the doctor may prescribe specific instructions to prepare prior to the operation.
If there is a live donor they can plan in advance for the operation. If the donor will come from a deceased person that is an organ donor they will need to wait for a call to go to the hospital. Once called it is imperative to go to the hospital immediately.
It is recommended that the patient begin fasting 8 hours prior to the procedure. If called because a donor was found begin fasting immediately.
What To Expect At The Hospital
When the patient arrives at the hospital they will be given a gown to put on. Often a sedative will be given to help the relax as well. An IV will be started in their arm, and catheters will be inserted in the neck and wrist to monitor the status of their heart and blood pressure. These catheters will also provide easy access to blood samples as necessary.
They will be placed on the operating table and if necessary hair will be removed from the place of the incision. An additional catheter will be placed in the bladder to drain it.
The anesthesiologist will sedate the patient and will proceed to insert a tube into their longs to allow him or her to control breathing with a ventilator. Throughout the procedure the anesthesiologist will monitor vital signs.
After the area for the incision is cleansed the surgeon will make his incisions. The lover will be separated from structures and surrounding organs. The surgeon will clamp the arteries and veins, and then remove the old liver.
The new liver will first be carefully inspected and then attached to the arteries, veins, and bile ducts. The surgeon will check for proper blood flow to the new liver and then close the incision.
After the procedure the patient will be taken to ICU where they will be monitored for several days. The overall hospital stay will be one to two weeks after the operation if all goes well.
Blood samples will be taken frequently to monitor how the body is reacting to the liver. In addition medication to prevent the body’s immune system from attacking the new liver will be administered. These medications will be adjusted until a good balance can be maintained. The patient will continue to take these medications for the rest of their life.
As recover progresses machines and tubes will be removed. Food will be reintroduced to the diet. First liquid and then solids when the patient is ready. Activity will be slowly introduced until the patient can walk unaided.
At Home After Liver Transplant Surgery
Once the patient is discharged from the hospital they will have very specific instructions from the doctor that must be followed. This includes how to bathe, symptoms to watch for, and medication to take.
There will be frequent follow up visits for several weeks to monitor the transplant. As long as the body reacts well the patient can return to a relatively normal life, but it will always be necessary to follow the doctor’s instructions, and take their medication.