What is a Liver Transplant?
A liver transplantation is an operation performed to replace a diseased liver with a healthy one from another person. An entire liver may be transplanted, or just a section. The liver may come from an organ donor, or from a family member who is willing to donate a part of his/her liver and is a suitable candidate to donate.
Why is a Liver Transplant Recommended?
Liver transplantation is recommended for children who have serious liver dysfunction and will not be able to live without having the liver replaced. The most common liver disease in children for which transplants are done is biliary atresia. Other liver diseases may include Alagille's Syndrome, alpha-1-antitrypsin deficiency, Wilson's disease, hepatitis, and hemochromatosis.
Where do Transplanted Livers Come From?
The majority of livers that are transplanted come from deceased organ donors. Organ donors are adults or children who have become critically ill (often due to an accidental injury) and will not live as a result of their illness or injury. If the doctor is an adult, he/she may have agreed to be an organ donor before becoming ill. Parents or spouses can also agree to donate a relative's organs. Donors can come from any part of the United States. This type of transplant is called a cadaveric transplant.
A child receiving a liver transplant may either get a whole liver, or a segment of one. If an adult liver is available and is an appropriate match for two children on the waiting list, the donor liver can be divided into two segments and each part is transplanted.
Living family members may also be able to donate a section of their liver. This type of transplant is called a living-related transplant. Children receiving a partial liver seem to do as well as those who receive a whole liver. Relatives who donate a portion of their liver can live healthy lives with the segment that remains.
How are Transplanted Livers Allocated?
The United Network for Organ Sharing (UNOS) is responsible for transplant organ distribution in the United States. UNOS oversees the allocation of many different types of transplants, including liver, kidney, pancreas, heart, lung, and cornea.
UNOS receives data from hospitals and medical centers throughout the country regarding adults and children who require a liver transplantation. The medical team that currently follows your child is responsible for sending the data to UNOS, and updating them as your child's condition changes.
Criteria have been developed to ensure that all people are on the waiting list are judged fairly as to the severity of their illness and the urgency of receiving a transplant. Once UNOS receives the data from local hospitals, people waiting for a transplant are placed on a waiting list and given a "status" code. The people in most urgent need of a transplant are placed highest on the status list and are given first priority when a donor liver becomes available.
When a donor organ becomes available, a computer searches all the people on the waiting list for a liver and sets aside those who are not good matches for the available liver. A new list is made from the remaining candidates. The person at the top of the specialized list is considered for the transplant. If he/she is not a good candidate, for whatever reason, the next person is considered,and so forth. Some reasons that people lower on the list might be considered before a person at the top include the size of the donor organ and the geographical distance between the donor and the recipient.
How is My Child Placed on the Waiting List for a New Liver?
An extensive evaluation must be completed before your child can be placed on the transplant list.Testing includes
- Blood tests
- Diagnostic tests
- Liver biopsy- A procedure in which tissue samples are removed (with a needle or during surgery) from the liver for examination under a microscope.
Tests are done to gather information that will help determine how urgent it is that your child is placed on the transplant list, as well as ensure the child receives a donor liver that is a good match. These tests include those to analyze the general health of the body, including the child's heart, lung, and kidney function, the child's nutritional status, and the presence of infection. Blood tests will help improve the chances that the donor liver will not be rejected. These tests may include:
- Liver enzymes
Elevated levels of liver enzymes can alert physicians to liver damage or injury, since the enzymes leak from the liver into the bloodstream under these circumstances.
- Bilirubin
Bilirubin is produced by the liver and is excreted in the bile. Elevated levels of bilirubin often indicate an obstruction of bile flow or a defect in the processing of bile by the liver.
- Albumin, total protein, and globulin
Below-normal levels of proteins made by the liver are associated with many chronic liver disorders.
- Clotting studies, such as prothrombin time (PT) and partial thromboplastin time (PTT)
Tests that measure the time it takes for blood to clot are often used prior to liver transplantation. Blood clotting requires vitamin K and proteins made by the liver. Liver cell damage and bile obstruction can both interfere with proper blood clotting.
Other blood tests will help improve the chances that the donor organ will not be rejected. They may include:
- Your child's blood type
Each person has a specific blood type: type A+, A -, B+, B -, AB+. AB -, O+, or O -. When receiving a transfusion, the blood received must be a compatible type with your child's type of blood, or an allergic reaction will occur. The same allergic reaction will occur if the blood contained within a donor organ enters your child's body during a transplant. Allergic reactions can be avoided by matching the blood types of your child and the donor.
- Kidney, heart, and other vital organ function tests
- Viral studies
These tests determine if your child has antibodies to viruses that may increase the likelihood of rejecting the donor organ, such as cytomegalovirus (CMV).
The diagnostic tests that are performed are extensive, but necessary to understand the complete medical status of your child. The following are some of the other tests that may be performed, although many of the tests are decided on an individual basis.
- Abdominal ultrasound (also called sonography)
A diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
- Liver biopsy
A procedure in which tissue samples are removed (with a needle or during surgery) from the liver for examination under a microscope
The transplant team will consider all information from interviews, your child's medical history, physical examination, and diagnostic tests in determining whether your child can be a candidate for liver transplantation. After the evaluation and once your child has been approved to have a liver transplant, your child will be placed on the United Network for Organ Sharing (UNOS) list.
How Long Will it Take to Get a New Liver?
There is no definite answer to this question. Sometimes, children wait only a few days or weeks before receiving a donor organ. If no living-donor is available, it may take months or years on the waiting list before a suitable donor organ is available. During this time, your child will have close follow-up with his/her physician and the transplant team. Various support groups are also available to assist you during this waiting time.
How Are We Notified When a Liver is Available?
Each transplant team has their own specific guidelines regarding waiting on the transplant list and being notified when a donor organ is available. In most instances, you will be notified by phone or pager that an organ is available. You will be told to come to the hospital immediately so your child can be prepared for the transplant.
What is Involved in Liver Transplant Surgery?
Once a liver becomes available to your child, you and your child will be immediately called to the hospital. The call can occur at any time, so you should always be prepared to go to the hospital, if needed. Once at the hospital, the child will have some more final blood work and tests to confirm the match of the liver.
The child will then go to the operating room. The liver transplantation surgery may require several hours, but will vary greatly depending on each individual case. During the surgery, a member of the transplant team will keep you informed on the progress of the transplantation.
