During the waiting time, patients on the liver transplant list are followed by the Liver Program at least every three months until transplantation. More frequent visits may be required, depending on severity of illness. We communicate with our patients' primary doctors to maintain general health, especially when there are other chronic conditions such as diabetes. Patients receive guidance about nutrition and where to go in case of emergency. The Liver Program's financial counselor is available to discuss financial concerns or changes in insurance status. If the patient does not have a primary care provider, the Liver Program will assist the patient in obtaining one to help with general health issues.
Patients waiting for liver transplantation receive a Model for End-Stage Liver Disease (MELD) score that determines their place on the waiting list. The MELD score is calculated from blood tests, which need to be updated at least every three months and more often in sicker patients. Those with higher MELD scores have more severe illness and are higher on the waiting list. Waiting times will vary according to severity of illness as well as blood type. Patients with blood type O tend to have longer waiting times compared with patients with other blood types, because type O is the most common blood type in the United States.
There are three ways to move up the donor list. First, patients can register as a recipient at more than one center. The multiple centers must be located in different regions--a patient can only be registered at one center in each region. Second, a patient can seek a living donor who is suitable to give a portion of the liver. Third, a patient can receive an expanded criteria deceased donor. Donors who may have increased risk of poorer graft function or disease transmission have expanded criteria organs. In some cases, an expanded criteria donor liver may be a perfectly acceptable and a potentially preferable way to obtain a timely transplant. The transplant team will discuss all these options with patients during transplant education.