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Evaluation 

The transplant work-up process at UT Southwestern Medical Center begins when a physician refers a patient to our service.  The nurse coordinator will set up appointments for the patient with many specialists on the transplant team to evaluate whether transplantation is an appropriate treatment. This is also an opportunity for the patient to ask questions and learn more about transplantation and life after the procedure. Some of the specialists the patient may be meeting at this time include:

• Transplant nurse coordinator
• Transplant social worker
• Transplant psychologist/psychiatrist
• Transplant hepatologist
• Transplant surgeon
• Transplant dietitian
• Transplant financial coordinator

Most evaluations are conducted on an outpatient basis over two or three days. The patient will be evaluated to determine the medical appropriateness of a transplant. The work-up is designed to:

1. Determine whether a transplant is needed
2. Detect problems that might complicate the transplant
3. Determine whether the patient has other conditions that make transplantation impossible

The evaluation consists of the following tests and procedures:

• Blood tests
• Chest X-ray
• Urine test
• Echocardiogram and EKG
• Ultrasound
• CT scan or an MRI

The following tests are sometimes needed to complete the evaluation:

• Liver biopsy
• Pulmonary Function Tests (PFTs)
• Arterial Blood Gases (ABG)

Transplant Selection Process

After the work-up has been completed and the patient has met with the key members of the transplant team, the case will be presented to the UT Southwestern Medical Center Transplant Selection Committee. Based on the test results and evaluations, the committee will decide if the patient is an appropriate candidate for transplantation. The committee may make any of the following recommendations:

1. The patient does not need a transplant.
2. The patient is not a transplant candidate because of other health problems.
3. The committee needs more information.
4. The committee would like to follow the patient for a period of time (generally 6-12 months) before placing the patient on the waiting list.
5. The patient is an acceptable candidate and can be placed on the transplant waiting list immediately.

The patient will not be placed on the waiting list until we notify the patient that he or she has been accepted. The patient will receive a written letter confirming their status on the waiting list.

Waiting List

The liver transplant waiting list is a computer list maintained by UNOS (United Network for Organ Sharing). The determination for who gets a liver is based on a formula that takes into consideration lab values such as creatinine, total bilirubin and INR. UNOS will then assign a MELD score based upon these values. The higher the MELD score, the sicker the patient and the higher the patient goes on the transplant waiting list. Livers are only matched for blood type (A, B, O, AB) and size. Unlike other organs, special tissue typing is not necessary to determine which liver donor makes the best match.

Once the patient is listed, we must be able to reach them at all times. It is important to provide us with several contact numbers. If we cannot find the patient, then we may be unable to do the transplant when an organ becomes available. If we need to contact the patient, we will call their home first.

While on the waiting list:

• The patient needs to let us know if he or she has a problem or is admitted to the hospital.
• Patients on the waiting list are seen in our clinic at least once every six months.
• When the patient is called in for the transplant, he or she must be at the hospital as soon as possible. (If out of town, the patient usually has plenty of time to return to the city and get to the hospital.) The patient should plan the trip to the hospital ahead of time. Don’t wait for the phone call from the transplant center to find transportation.

Waiting Period

After the patient has been listed, the waiting period begins. This time varies depending upon organ availability and the severity of the patient’s illness. During this time, the patient will be seen in the UT Southwestern Medical Center Transplant Clinic and will need to have regular lab work to maintain their position on the UNOS waiting list.

It is very important that the patient contact our office with any changes in their phone number, address or insurance coverage. If the patient is hospitalized or the disease worsens, he or she must contact the coordinator. Any medical changes may alter the patient’s position on the waiting list.

The patient will need to be available ─ by phone or pager ─ at all times so that when an organ becomes available the coordinator can reach the patient. The patient will be required to come to UT Southwestern University Hospital immediately. The transplant will usually occur within six to 12 hours of initial contact.