What happens after my doctor tells me that I need a liver transplant?

The following information is based on procedures specific to the VA transplant center in Portland, Oregon. Recovery and follow-up procedures at other transplant centers may be slightly different from those in Portland. The evaluation process is complex and unique to each patient. The process begins at your local VA and will then continue at the transplant center you have been referred to. It is extremely important to not miss any appointments. Failure to show for appointments significantly decreases your chance of being accepted for transplant.

Evaluation: First steps

If you decide to use your VA healthcare benefits, the first step towards a liver transplant is getting approval for an in-person evaluation at one of the VA transplant centers. There are 6 VA transplant centers: Houston, Texas, Nashville, Pittsburgh, Portland, Madison, and Richmond. Your evaluation and transplant may take place in a city or state different from where you live. If you are using VA benefits, the VA is responsible for you and your support person's travel and lodging to the transplant center that you have listed as your preference.

This process begins when your referring provider (usually a hepatologist, although not always) orders tests to evaluate your liver disease. If he or she believes you would benefit from a transplant, they will discuss this possibility with you and your support person. Should you decide that liver transplantation is something you would like to be considered for, you will do further tests and evaluations. This is called the "transplant evaluation" or "work-up." This does not mean you are guaranteed to receive a transplant.

One of the first steps is often evaluation by a psychologist and a social worker trained in evaluating patients for liver transplantation. Once this is completed and they feel you are a reasonable candidate from their standpoint (remember the importance of social support), other medical tests will be ordered to make sure you are healthy enough to go through with the liver transplant operation. These tests include evaluation of your heart and lungs (chest x-ray, echocardiogram, EKG, pulmonary "breathing" tests, cardiac stress test); numerous blood tests and further evaluation of your liver (abdominal CT scan), and a dental evaluation. In some cases, the work-up may reveal a medical or psychosocial problem that would either 1) lead to further testing or evaluation or 2) exclude you as a transplant candidate.

Once the above is completed and you are found to be a reasonable candidate by your primary physician or hepatologist, the test results are assembled and forwarded to the VA National Transplant Program in Washington D.C. as part of what is called your "transplant packet." A panel of physicians will review your transplant packet. If they decide that your condition warrants going further, they will assign you to a VA transplant center and contact the center about your case. The VA transplant center will then contact your referring medical provider to tell them where and when your "in-person" or telehealth evaluation will take place. This process takes roughly one to two months from the time your packet is submitted to the Transplant Office in Washington, DC.

In some cases, the panel may decide to defer a decision because they need more information first.

The in-person evaluation at the transplant center (the final steps of the "evaluation process") usually takes approximately one week, although it may take longer. Recall that your support person(s)/caregiver will need to be with you for this evaluation. Lodging will be provided for you both. You will meet members of the transplant team. You may be asked to repeat some of the same tests you have already done in order to have the most recent information on your current health. Your mental and physical health will be re-evaluated, and the transplant team will ask you questions about your home/personal life. You will be asked to complete an advance directive, which is a written document that tells what you want or do not want if you become unable to make your wishes about health care treatments known. At the time of your visit to the transplant center, you will speak with the hepatologist and a surgeon. The surgeon will go over the procedure, risks, and some of the issues specific to surgery. You and your support person will have plenty of opportunity to ask questions during your stay there.