Thank you to all who attended our fundraiser on Sat. April 4th at the Fredericksburg Country Club. We raised close to $25,000 for the Brian Buckley Fund! Thank you to those who could not attend, but have made contributions.
Great thanks go out to our three major sponsors:
Medicorp, Federal Job Search.com, and The Kemore Inn
and for the wonderful contributions of time, ideas and talents:
Cheryl Kimball, Megan D'Lugos, Stacey Guthiel, John Keville, Bruce Strickland, Dave Smalley, Melissa Crisp, Justin Marston, Amy Strickland, Gerardo Despian, Tina Jackson, Caroline Smalley, Kathleen and Phillip Atkins, Mary Elizabeth McManus, Wendy La Rue, Betsy Glassie, Jasmine Larimer, the Piedmont Caledonia Pipes and Drums, and Drivin' South and The Glass Onion Band who ROCKED THE HOUSE!! and all of our generous donors and contributors.
Monday, April 6, 2009
DONATE TO BRIAN BUCKLEY FUND HERE
http://www.hcapto.com/brianbuckleyfund.html
If you would like to make a donation to the fund to support Brian's liver transplant, please do so here. This is a direct link to the Buckley's non-profit fund.
Thank you very much.
If you would like to make a donation to the fund to support Brian's liver transplant, please do so here. This is a direct link to the Buckley's non-profit fund.
Thank you very much.
Tuesday, March 24, 2009
Great Response from Living Donors
Today the people at Georgetown said they have been getting a great response from potential living donors. They are only able to screen one person at a time, but we feel hopeful that they are getting a good pool of potential candidates.
We have received many RSVPs so far to the event for Brian on April 4th, and thanks go out to Megan D'Lugos, Tina Jackson, Melissa Crisp, Justin Marston, Stacey Guthiel, Arleen Squillante, Kathleen Atkins and Cheryl Kimball for all of the amazing work they have done getting items donated for our auction! Thank you to the many businesses and individuals who have been donating their services, goods and other contributions.
The music promises to be terrific! Please RSVP to Cheryl Kimball at 540/318-0778 if you have not already. Thanks so much.
We have received many RSVPs so far to the event for Brian on April 4th, and thanks go out to Megan D'Lugos, Tina Jackson, Melissa Crisp, Justin Marston, Stacey Guthiel, Arleen Squillante, Kathleen Atkins and Cheryl Kimball for all of the amazing work they have done getting items donated for our auction! Thank you to the many businesses and individuals who have been donating their services, goods and other contributions.
The music promises to be terrific! Please RSVP to Cheryl Kimball at 540/318-0778 if you have not already. Thanks so much.
Wednesday, March 18, 2009
Channel 9 News Story - aired 3/17
Peggy Fox did this story yesterday on Channel 9. Please send this link on to anyone you think might be interested in hearing about Brian or helping with his situation. Many thanks.
http://www.wusa9.com/news/local/story.aspx?storyid=83004&catid=188
http://www.wusa9.com/news/local/story.aspx?storyid=83004&catid=188
Please RSVP for event by 3/27 - very important
Fundraising information: We are hoping to raise as much money as possible for the Buckleys. They have $120,000 co-pay for the surgery. In addition, Brian has not been able to work for the last 18 months because he is just too sick. There is no telling when he will be well enough to work. We are also looking for the community to spread the word on making donations directly to the Brian Buckley Fund. Checks can be made payable to Brian Buckley Fund - you can bring them to the event on April 4th (Please RSVP for the event by March 27 to Cheryl Kimball; 540-318-0778 or Mary Despian 540-899-0186), or mail checks to:
Brian Buckley Fund
15960 Dorset Road
Laurel, MD 20707
Liver Donor information: Brian needs a blood type "O" donor (negative or positive), his donor needs to have a similar body type to Brian - but the people at Georgetown can give more information on the details of that. They need to be roughly between 18-50 years old, and in good health. They will have to go through tests to include: extensive blood work, MRI, EKG, Xrays and a physical. A lot of the testing can be done on Saturdays, but a few tests have to be done during the work week. The people at Georgetown try to be accommodating with the testing to fit potential donors' schedules. In a broad brush -- the donor is looking at a five hour surgery where 40-60% of his liver will be removed and transplanted to Brian. The donor will have a 7-10 day hospital stay after the surgery and approximately 6 weeks of recuperation at home. In 4-6 weeks the donor's liver grows back to the original size. All expenses related to the testing, surgery and hospital stay are completely covered.
Potential Donor Coordinator at Georgetown: Charlotte Nicholson - (202) 444-7287
Brian Buckley Fund
15960 Dorset Road
Laurel, MD 20707
Liver Donor information: Brian needs a blood type "O" donor (negative or positive), his donor needs to have a similar body type to Brian - but the people at Georgetown can give more information on the details of that. They need to be roughly between 18-50 years old, and in good health. They will have to go through tests to include: extensive blood work, MRI, EKG, Xrays and a physical. A lot of the testing can be done on Saturdays, but a few tests have to be done during the work week. The people at Georgetown try to be accommodating with the testing to fit potential donors' schedules. In a broad brush -- the donor is looking at a five hour surgery where 40-60% of his liver will be removed and transplanted to Brian. The donor will have a 7-10 day hospital stay after the surgery and approximately 6 weeks of recuperation at home. In 4-6 weeks the donor's liver grows back to the original size. All expenses related to the testing, surgery and hospital stay are completely covered.
Potential Donor Coordinator at Georgetown: Charlotte Nicholson - (202) 444-7287
Tuesday, March 17, 2009
Update on Brian - march 17
Today Peggy Fox did a news story for Channel 9 on Brian. She interviewed Brian and Shirley in Maryland and then came down to Fredericksburg and interviewed some of his patients and friends. The story airs tonight at 7:00 on channel 9. We are hoping it will increase awareness of his situation to a larger audience to help find a potential donor.
We continued to work on the fundraising event today, finding several more auction items and addressing envelopes for the invitations.
We continued to work on the fundraising event today, finding several more auction items and addressing envelopes for the invitations.
O
From OrganDonor.Gov:
Waiting list candidates
100,978
as of 03/06/2009
Transplants January - November 2008
25,630
as of 02/27/2009
Donors January - November 2008
12,936
as of 02/27/2009
What Can Be Donated
Organs
Tissue
Stem Cells
Blood
Types of Donation
Organ and Tissue Donation from Living Donors
Donation After Brain Death
Donation After Cardiac Death (DCD)
Whole Body Donation
Who Can Donate
Most People Can Donate
You Are Never Too Old
Medical Condition? — Don't Rule Yourself Out
Who Gets a Liver?The average waiting time for a liver is 796 days. (UNOS/OPTN Annual Report 2003) Candidates who need a liver transplant are given a MELD/PELD score (Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease) that indicates how urgently they need the organ. A liver will be offered to the candidate with a matching tissue type and the highest MELD/PELD score first (the high score indicates the greatest need.) If the first donor’s surgeon does not accept the organ then the liver specialists at UNOS will offer the liver to matched patients according to the MELD/PELD scores until the organ is accepted. Geographic factors are also taken into consideration, but livers can stay healthy outside the body for 12 to 24 hours so the UNOS liver team has greater flexibility than the teams that work with hearts and lungs ( Partnering With Your Transplant Team (PDF) , page 10). See the OPTN/UNOS Allocation of Livers Policy (PDF) for details. To learn more about how MELD/PELD scores are assigned, see the OPTN MELD/PELD calculators
Who Gets a Heart?The average national waiting time for a heart is 230 days. (UNOS/OPTN Annual Report 2003) People waiting for a heart transplant are assigned a status code, which indicates how urgently they need a heart. Because thoracic organs such as the heart and lungs can only survive outside the body for 4 to 6 hours (Partnering With Your Transplant Team (PDF) , page 10), they are given first to people who live near the place where the donor is hospitalized. If no one near the donor is a match for the heart, the transplant team starts searching farther away through a series of zones in a specific sequence. See the OPTN/UNOS Allocation of Thoracic Organs Policy (PDF) for details.
Who Gets a Lung?The average waiting time for a lung is 1,068 days. (UNOS/OPTN Annual Report 2003) The UNOS team divides people waiting for lung transplants into two groups – people who need only one new lung and those who need two. The lung allocation system uses clinical information—including lab values, test results, and disease diagnosis—to estimate the urgency of a candidate’s need for transplant and the likelihood of prolonged survival following the transplant. This lung allocation score, as well as blood group, age, and distance from the donor hospital are considered to determine the order in which a donated lung is offered to candidate recipients. Distance is important because lungs can only survive outside the body for 4 to 6 hours (Partnering With Your Transplant Team (PDF) , page 10); they are offered first to people near the donor. If no one near the donor is a match for the lung, the transplant team starts searching farther away through a series of zones in a specific sequence. A pair of lungs will either be given to one person who needs them both, or divided between two people who need single lung transplants. See the OPTN/UNOS Allocation of Thoracic Organs Policy (PDF) for details.
Who Gets a Kidney?The average waiting time for a kidney is 1,121 days. (UNOS/OPTN Annual Report 2003) When a UNOS team selects possible recipients for a donor kidney, they consider a variety of characteristics of both the donor and the recipient, including tissue match, blood type, blood antibody levels (which show how active the immune system is at the current time – too much activity increases the risk of rejection), length of time on the waiting list, whether the recipient is a child, whether the body sizes of the donor and recipient are a good match, and geographic factors. Kidneys can stay healthy outside the body for between 48 and 72 hours, so the UNOS kidney team can consider many more candidates than the heart or lung teams
Who Gets a Pancreas?The average waiting time for a pancreas is 501 days. (UNOS/OPTN Annual Report 2003) The pancreas can remain healthy outside the body for 12 to 24 hours .A person who is offered a donor pancreas can be selected from people waiting for a pancreas transplant alone, a kidney-pancreas combination transplant, or a combined kidney-pancreas-islet transplant. The Islets of Langerhans are cells inside the pancreas that secrete insulin. They can be transplanted by themselves if the whole organ does not need to be used. An islet transplant is the kind of transplant that is most useful for people with diabetes whose pancreas is healthy but the Islets of Langerhans, do not make insulin. Insulin is needed to break down sugar. People who have had pancreatitis (inflammation of the pancreas) and have damage all through their pancreas need the whole organ. See the OPTN/UNOS Allocation of Pancreas Policy (PDF) for details.
April is National Donate Life Month
30 Days to Help Save a Life: What to Do in April
National Donate Life Month was established in 2003. Every day in April, people across the U.S. make a special effort to celebrate the tremendous generosity of those who have saved lives by becoming organ, tissue, marrow, and blood donors and to encourage more Americans to follow their fine example.
Make it known: I want to be a donor
Register with your State Donor Registry, if available.
Say YES to donation on your driver's license.
Tell your family, friends, physician, and faith leader that you want to be a donor.
Fill out and sign a donor card, have it witnessed, carry it with you.
Tell someone: The need is great and growing.
More than 98,000 people are in need of an organ for transplant.
Each day, about 77 people get the organ transplant that gives them a second chance, but 17 to 19 others die because they did not receive an organ transplant.
More than half the people on the waiting list for a donated organ are racial or ethnic minorities. Chances of getting a transplant increase if donor and recipient share the same racial/ethnic background.
Get involved: Become a donation advocate.
Encourage your company, association, union, or other organizations to which you may belong to join the Workplace Partnership for Life.
Promote and support work site donation campaigns.
Tell your local high school about Decision Donation, a school program that educates students about donation.
Participate in local National Donate Life Month events sponsored by your local organ procurement organization.
From the Mayo Clinic
(http://www.mayoclinic.org/liver-transplant/livingdonorlivertransplant.html):
The number of patients awaiting liver transplantation in the United States greatly exceeds the supply of cadaver donor organs. More than 15,000 patients are currently registered on the liver transplant waiting list of the United Network for Organ Sharing (UNOS), while only about 4,500 cadaver donor livers become available for transplantation each year. Cadaver donor organ availability appears to have reached a plateau despite many initiatives intended to increase organ donation.
The waiting time for liver transplantation has increased steadily each year, rising from approximately one month in 1988 to more than a year in 1999. Currently, more than one-third of patients in the United States wait longer than two years for a liver transplant, and more patients die each year while awaiting transplantation. There is a critical shortage of donor organs, and this problem will continue to worsen in the foreseeable future.
From the USC website
http://www.ucsfhealth.org/adult/medical_services/organ_transplants/liver/liver_donor_transplant_facts.html:
Living Donor Liver Transplant: The Facts
In the United States, there are over 17,000 patients on the liver waiting list, but only enough donated livers to perform about 5,000 transplants per year. As a result, more than 1,700 patients die each year while on liver waiting lists. Technological advances -- along with the liver's unique ability to regenerate itself -- have allowed UCSF Medical Center transplant surgeons to perform living donor liver transplants.
Here are some facts on living donor liver transplantation:
· It began over a decade ago to enable adults to donate part of their liver to children
· In the mid-1990s, countries with limited cadavers began adult-to-adult living donor transplants
· Surgeons at UCSF Medical Center performed their first adult-to-child procedure in 1993 and the first adult-to-adult procedure in January, 2000 Since 2000, UCSF Medical Center has performed more than 90 adult-to-adult transplants
· A living donor doesn't have to be a blood relative, but must have a compatible blood type
· During surgery about 40 percent o 60 percent of the donor's liver is removed
· The average hospital stay for both recipient and donor is seven days; the recovery time for donors is about two months and for recipients is about six to 12 months
· The liver begins to regenerate itself almost immediately
· Within eight weeks, both the donor's and the recipient's livers will be almost completely regenerated
Preparation
In living donor liver transplantation, a piece of liver is removed from a living donor and transplanted into a recipient. The procedure, performed after the diseased liver has been removed, is possible because the liver regenerates or grows. The liver's unique ability to regenerate itself -- combined with technological advances -- allows more people to be donors.
Regeneration happens over a short period, possibly days to weeks and certainly within eight weeks. When surgeons remove a piece of the donor's liver, the part that remains grows back quickly to its original size.
More than a decade ago, surgeons around the world began performing living donor transplants using adult donors for children who needed transplants. Surgeons at UCSF Medical Center have performed these transplants between adults and children since 1992.
Evaluation
Once your blood type is confirmed, you will receive a detailed confidential questionnaire about your family medical history, lifestyle and other information. The evaluation includes a series of tests to check your blood type and overall health. Tests include:
· Chest X-ray
· Electrocardiogram (EKG or ECG)
· Abdominal ultrasound
A doctor who is not a member of the transplant team will complete your medical evaluation and serve as the "donor advocate" doctor throughout your surgery and recovery.
From eMedicineHealth Website
http://www.emedicinehealth.com/liver_transplant/article_em.htm
Liver Transplant Overview
Currently, more than 17,000 people in the United States are waiting for liver transplants. According to the United Network for Organ Sharing (UNOS), about 5,300 liver transplantations were performed in the United States in 2002.
The liver is the second most commonly transplanted major organ, after the kidney, so it is clear that liver disease is a common and serious problem in this country. It is important for liver transplant candidates and their families to understand the basic process involved with liver transplants, to appreciate some of the challenges and complications that face liver transplant recipients (people who receive livers), and to recognize symptoms that should alert recipients to seek medical help.
Some basics are as follows:
The liver donor is the person who gives, or donates, all or part of his or her liver to the waiting patient who needs it. Donors are usually people who have died and wish to donate their organs. Some people, however, donate part of their liver to another person (often a relative) while living.
Orthotopic liver transplantation refers to a procedure in which a failed liver is removed from the patient's body and a healthy donor liver is transplanted into the same location. In this case, the liver donor is someone who has recently died. The procedure is the most common method used to transplant livers.
With a living donor transplant, a healthy person donates part of his or her liver to the recipient. This procedure has been increasingly successful and shows promise as a solution to the shortage of liver donors. It is becoming the most frequent option in children, partly because child-sized livers are in such short supply. Other methods of transplantation are used for people who have potentially reversible liver damage or as temporary measures for those who are awaiting liver transplants. These other methods are not discussed in detail in this article.
The body needs a healthy liver. The liver is an organ located in the right side of the abdomen below the ribs. The liver has many vital functions.
It is a powerhouse that produces varied substances in the body, including (1) glucose, a basic sugar and energy source; (2) proteins, the building blocks for growth; (3) blood-clotting factors, substances that aid in healing wounds; and (4) bile, a fluid stored in the gallbladder and necessary for the absorption of fats and vitamins.
As the largest solid organ in the body, the liver is ideal for storing important substances like vitamins and minerals. It also acts as a filter, removing impurities from the blood. Finally, the liver metabolizes and detoxifies substances ingested by the body. Liver disease occurs when these essential functions are disrupted. Liver transplants are needed when damage to the liver severely impairs a person's health and quality of life.
Determining whose need is most critical: The United Network for Organ Sharing uses measurements of clinical and laboratory problems to divide patients into groups that determine who is in most critical need of a liver transplant. In early 2002, UNOS enacted a major modification to the way in which people were assigned the need for a liver transplant. Previously, patients awaiting livers were ranked as status 1, 2A, 2B, and 3, according to the severity of their current disease. Although the status 1 listing has remained, all other patients are now classified using the Model for End-Stage Liver Disease (MELD) scoring system if they are aged 18 years or older, or the Pediatric End-Stage Liver Disease (PELD) scoring system if they are younger than 18 years. These scoring methods were set up so that donor livers could be distributed to those who need them most urgently.
Status 1 (acute severe disease) is defined as a patient with only recent development of liver disease who is in the intensive care unit of the hospital with a life expectancy without a liver transplant of fewer than 7 days.
MELD scoring: This system is based on the risk or probability of death within 3 months if the patient does not receive a transplant. The MELD score is calculated based only on laboratory data in order to be as objective as possible. The laboratory values used are a patient's creatinine, bilirubin, and international normalized ratio, or INR (a measure of blood-clotting time). A patient's score can range from 6 to 40. In the event of a liver becoming available to 2 patients with the same MELD score and blood type, time on the waiting list becomes the deciding factor.
PELD scoring: This system is based on the risk or probability of death within 3 months if the patient does not receive a transplant. The PELD score is calculated based on laboratory data and growth parameters. The laboratory values used are a patient's albumin, bilirubin, and INR (measure of blood-clotting capability). These values are used together with the patient's degree of growth failure to determine a score that can range from 6 to 40. As with the adult system, if a liver were to become available to two similarly sized patients with the same PELD score and blood type, the child who has been on the waiting list the longest will get the liver.
Based on this system, livers are first offered locally to status 1 patients, then according to patients with the highest MELD or PELD scores. Next, if there are no local recipients, the liver is offered regionally, in the same order, and finally, on a national level.
Status 7 (inactive) is defined as patients who are considered to be temporarily unsuitable for transplantation.
Who may not be given a liver: A person who needs a liver transplant may not qualify for one because of the following reasons:
Active alcohol or substance abuse: Persons with active alcohol or substance abuse problems may continue living the unhealthy lifestyle that contributed to their liver damage. Transplantation would only result in failure of the newly transplanted liver.
Cancer: Cancers in locations other than just the liver weigh against a transplant.
Advanced heart and lung disease: These conditions prevent a transplanted liver from surviving.
Severe infection: Such infections are a threat to a successful procedure.
Massive liver failure: This type of liver failure accompanied by associated brain injury from increased fluid in brain tissue rules against a liver transplant.
HIV infection
The transplantation team: If a liver transplant is recommended by a primary doctor, the person must also be evaluated by a transplantation team. The usual candidate has advanced liver disease but is otherwise in good health.
The transplantation team usually consists of a transplant coordinator, a hepatologist (liver specialist), and a transplant surgeon. It may be necessary to see a cardiologist (heart specialist) and pulmonologist (lung specialist), depending on the recipient's age and health problems.
The potential recipient may also see a psychiatrist because the liver transplantation process may be a very emotional experience that may require life adjustments.
The liver specialist and the primary doctor manage the person's health issues until the time of transplantation.
A social worker may be involved in the case. This person assesses and helps develop the patient's support system, a central group of people on whom the patient can depend throughout the transplantation process. A positive support group is very important to a successful outcome. The support group can be instrumental in ensuring that the patient takes all the required medicines, which may have unpleasant side effects. The social worker also checks to see that the recipient is taking medications appropriately.
The search for a donor: Once a person is accepted for transplantation, the search for a suitable donor begins. All people waiting are placed on a central list at UNOS. Local and national agencies are involved in finding suitable livers. The United States has been divided into regions to try to fairly distribute this scarce resource. Many donors are victims of some sort of trauma and have been declared brain dead. A donor with the right blood type and similar body weight is sought to help reduce the risk of rejection. Rejection occurs when the patient's body attacks the new liver.
With the shortage of donor organs and the need to match donor and patient blood and body type, the waiting time may be long. A patient with a very common blood type has less chance of quickly finding a suitable liver because so many others with his or her blood type also need livers. Such patients are likely to receive a liver only if they are in the intensive care unit and have very severe liver disease. A patient with an uncommon blood type may receive a transplant more quickly if a matching liver is identified because people higher on the transplant list may not have this unusual blood type.
The length of time a person waits for a new liver depends on blood type, body size, and how soon the patient needs a transplant. During the wait, it is important to stay in good physical health. Following a nutritious diet and a light exercise plan are important. In addition, regularly scheduled visits with the transplantation team may be scheduled for health examinations. A patient also receives vaccines against certain bacteria and viruses that are more likely to develop after the transplantation because of immunosuppression (antirejection) medication.
Living donors: Avoiding a long wait is possible if a person with liver disease has a living donor who is willing to donate part of his or her liver. This procedure is known as living donor liver transplantation. The donor must have major abdominal surgery to remove the part of the liver that will become the graft (also called a liver allograft, which is the name for the transplanted piece of liver). As techniques in liver surgery have improved, the risk of death in people who donate a part of their liver has dropped to about 1%. The donated liver will be transplanted into the patient. The amount of liver that is donated will be about 50% of the recipient's current liver size. Within 6-8 weeks, both the donated pieces of liver and the remaining part in the donor grow to normal size.
Until 1999, living donor transplantation was generally considered experimental, but it is now an accepted method. In the future, this procedure will be used more often because of the severe lack of livers from recently deceased donors.
The live donor procedure also allows greater flexibility for the patient because the procedure may be done for people who are in the lower stages of liver disease.
At present, only patients with the most severe liver disease are allowed to receive transplants. These are often patients in intensive care units who have a very short life expectancy, often classified as stage 1, or patients with very high MELD or PELD scores.
With a living donor, patients healthy enough to live at home may still receive a liver transplant. The living donor transplantation may also be more widely used because of the increase in hepatitis C virus infection and the importance of quickly finding transplants for people who have liver cancer. Finally, the success with living donor kidney transplants has encouraged increased use of such techniques.
Recipients of a living donor liver transplant go through the same evaluation process as those receiving a cadaveric liver (a liver from someone who has died). The donor also has blood tests and imaging studies of the liver performed to make sure it is healthy. The living donors, as with the deceased donors, must have the same blood type as the recipient. They must be aged 18-55 years, have a healthy liver, and be able to tolerate the surgery. The donor cannot receive any money or other form of payment for the donation. Finally, the donor must have a good social support system to aid in emotional aspects of going through the procedure.
People who have liver disease or alcoholism are not allowed to donate part of their liver. Those who smoke chronically or who are obese or pregnant also cannot make such donations. If the potential donor does not have a compatible blood type or does not meet these criteria, the recipient may continue to be listed on the UNOS registry for a transplant from a deceased donor.
A donor is found: Once a suitable cadaveric liver donor has been found, the patient is called to the hospital. It is best that the patient carry a beeper as he or she rises on the transplant list, so that getting to the hospital can be done quickly. Donor livers function best if they are transplanted within 8 hours, although they can be used for up to 24 hours. Presurgical studies, including blood tests, urine tests, chest x-rays, and an ECG, are performed. Before surgery, an IV line is started. The patient also receives a dose of steroids-one of the medicines to prevent rejection of the new liver-and a dose of antibiotics to prevent infection. The liver transplantation procedure takes about 6-8 hours. After the transplantation, the patient is admitted to the intensive care unit.
Liver Transplant Causes
Liver disease severe enough to require a liver transplant can come from many causes. Doctors have developed various systems to determine the need for the surgery. Two commonly used methods are by specific disease process or a combination of laboratory abnormalities and clinical conditions that arise from the liver disease. Ultimately, the transplantation team takes into account the type of liver disease, the person's blood test results, and the person's health problems in order to determine who is a suitable candidate for transplantation.
In adults, chronic active hepatitis and cirrhosis (from alcoholism, unknown cause, or biliary) are the most common diseases requiring transplantation. In children, and in adolescents younger than 18 years, the most common reason for liver transplantation is biliary atresia, which is an incomplete development of the bile duct.
Laboratory test values and clinical or health problems are used to determine a person's eligibility for a liver transplant.
For certain clinical reasons, doctors may decide that a person needs a liver transplant. These reasons may be health problems that the person reports, or they may be signs that the doctor notices while examining the potential recipient. These signs usually occur when the liver becomes severely damaged and forms scar tissue, a condition known as cirrhosis. The most common clinical and quality-of-life indication for a liver transplant is ascites, or fluid in the belly due to liver failure. In the early stage of this problem, ascites may be controlled with medicines (diuretics) to increase urine output and with dietary modifications (limiting salt intake). Another serious consequence of liver disease is hepatic encephalopathy. This is mental confusion, drowsiness, and inappropriate behavior due to liver damage. Both ascites and encephalopathy are used in the current classification system to determine the severity of liver disease.
Several other clinical problems may arise from liver disease. Infection in the abdomen, known as bacterial peritonitis, is a life-threatening problem. It occurs when bacteria or other organisms grow in the ascites fluid. Liver disease causes scarring, which makes blood flow through the liver difficult and may increase the blood pressure in one of the major blood vessels that supply it. This process may result in serious bleeding. Blood may also back up into the spleen and cause it to increase in size and to destroy blood cells. Blood may also go to the stomach and esophagus (swallowing tube). The veins in those areas may grow and are known as varices. Sometimes, the veins bleed and may require a gastroenterologist to pass a scope down a person's throat to evaluate them and to stop them from bleeding. These problems may become very difficult to control with medicines and can be a serious threat to life. A liver transplant may be the next step recommended by the doctor.
From WebMD:
Liver Transplantation
The liver is the body's largest internal organ, weighing about 3 pounds in adults. It is located below the diaphragm on the right side of the abdomen.
The liver performs many complex functions in the body, including:
· Produces most proteins needed by the body.
· Metabolizes, or breaks down, nutrients from food to produce energy, when needed.
· Prevents shortages of nutrients by storing certain vitamins, minerals and sugar.
· Produces bile, a compound needed to digest fat and to absorb vitamins A, D, E and K.
· Produces most of the substances that regulate blood clotting.
· Helps your body fight infection by removing bacteria from the blood.
· Removes potentially toxic byproducts of certain medications.
When Is a Liver Transplant Needed?
Liver transplantation is considered when the liver no longer functions adequately (liver failure). Liver failure can occur suddenly (acute liver failure) as a result of infection or complications from certain medications or it can be the end result of a long-term problem. The following conditions may result in liver failure:
· Chronic hepatitis with cirrhosis.
· Primary biliary cirrhosis (a rare condition where the immune system inappropriately attacks and destroys the bile ducts causing liver failure).
· Sclerosing cholangitis (scarring and narrowing of the bile ducts inside and outside of the liver causing the backup of bile in the liver which can lead to liver failure).
· Biliary atresia (malformation of the bile ducts).
· Alcoholism.
· Wilson's disease (a rare inherited disease with abnormal deposition of copper throughout the body, including the liver, causing it to fail).
· Hemochromatosis (a common inherited disease where the body is overwhelmed with iron).
· Alpha-1 antitrypsin deficiency (an abnormal accumulation of alpha-1 antitrypsin protein in the liver, resulting in cirrhosis).
· Liver cancer.
How Are Candidates for Liver Transplant Determined?
Evaluations by specialists from a variety of fields are needed to determine if a liver transplant is appropriate. The evaluation includes a review of your medical history and a variety of tests. Many healthcare facilities offer an interdisciplinary approach to evaluate and to select candidates for liver transplantation. This interdisciplinary healthcare team may include the following professionals:
· Liver specialist (hepatologist).
· Transplant surgeons.
· Transplant coordinator, usually a registered nurse who specializes in the care of liver-transplant patients (this person will be your primary contact with the transplant team).
· Social worker to discuss your support network of family and friends, employment history, and financial needs.
· Psychiatrist to help you deal with issues, such as anxiety and depression, which may accompany the liver transplantation.
· Anesthesiologist to discuss potential anesthesia risks.
· Chemical dependency specialist to aid those with history of alcohol or drug abuse.
· Financial counselor to act as a liaison between a patient and his or her insurance companies.
Which Tests Are Required Before Getting a Liver Transplant?
You will need to bring all of your previous doctor records, X-rays, liver biopsy slides and a record of medications to your pre-evaluation for a liver transplant. To complement and to update previous tests, some or all of the following diagnostic studies are generally performed during your evaluation.
· Computed tomography, which uses X-rays and a computer to generate pictures of the liver, showing its size and shape.
· Doppler ultrasound to determine if the blood vessels to and from your liver are open.
· Echocardiogram to help evaluate your heart.
· Pulmonary function studies to determine your lungs' ability to exchange oxygen and carbon dioxide.
· Blood tests to determine blood type, clotting ability, and biochemical status of blood and to gauge liver function. AIDS testing and hepatitis screening are also included.
If specific problems are identified, additional tests may be ordered.
How Does the Liver Transplant Waiting List Work?
If you become an active liver transplant candidate, your name will be placed on a waiting list. Patients are listed according to blood type, body size, and medical condition (how ill they are). Each patient is given a priority score based on three simple blood tests (creatinine, bilirubin, and INR). The score is known as the MELD (model of end stage liver disease) score in adults and PELD (pediatric end stage liver disease) in children.
Patients with the highest scores are transplanted first. As they become more ill, their scores will increase and therefore their priority for transplant increases, allowing for the sickest patients to be transplanted first. A small group of patients who are critically ill from acute liver disease have the highest priority on the waiting list.
It is impossible to predict how long a patient will wait for a liver to become available. Your transplant coordinator is always available to discuss where you are on the waiting list.
Where Does a Liver for a Transplant Come From?
There are two types of liver transplant options: living donor transplant and deceased donor transplant.
· Living donor. Living donor liver transplants are an option for some patients with end-stage liver disease. This involves removing a segment of liver from a healthy living donor and implanting it into a recipient. Both the donor and recipient liver segments will grow to normal size in a few weeks.
The donor, who may be a blood relative, spouse, or friend, will have extensive medical and psychological evaluations to ensure the lowest possible risk. Blood type and body size are critical factors in determining who is an appropriate donor.
Recipients for the living donor transplant must be active on the transplant waiting list. Their health must also be stable enough to undergo transplantation with excellent chances of success.
· Deceased Donor. In deceased donor liver transplant, the donor may be a victim of an accident or head injury. The donor's heart is still beating, but the brain has stopped functioning. Such a person is considered legally dead, because his or her brain has permanently and irreversibly stopped working. At this point, the donor is usually in an intensive-care unit.
The identity of a deceased donor and circumstances surrounding the person's death are kept confidential.
Screening for Liver Transplant Donors
Hospitals will evaluate all potential liver transplant donors for evidence of liver disease, alcohol or drug abuse, cancer, or infection. Donors will also be tested for hepatitis, AIDS, and other infections. If this screening does not reveal problems with the liver, donors and recipients are matched according to blood type and body size. Age, race, and sex are not considered.
The transplant team will discuss your transplantation options with you at the time of your pre-transplant evaluation, or you can contact the transplant team for more information.
What Happens When They Find Liver Transplant Match?
When a liver has been identified for you, a transplant coordinator will contact you by telephone or by pager. Make sure that you do not eat or drink anything once you have been called to the hospital. The transplant coordinator will notify you of any additional instructions. When you arrive at the hospital, additional blood tests, an electrocardiogram, and a chest X-ray will generally be taken before the operation. You also may meet with the anesthesiologist and a surgical resident. If the donor liver is found to be acceptable you will proceed with the transplant. If not, you will be sent home to continue waiting.
What Happens During the Liver Transplant Operation?
Liver transplants usually take from six hours to 12 hours. During the operation, surgeons will remove your liver and will replace it with the donor liver. Because a transplant operation is a major procedure, surgeons will need to place several tubes in your body. These tubes are necessary to help your body carry out certain functions during the operation and for a few days afterward.
Tube Placement
· A tube will be placed through your mouth into your windpipe (trachea) to help you breathe during the liver transplant operation and for the first day or two following the operation. The tube is attached to a ventilator that will expand your lungs mechanically.
· A nasogastric (N/G) tube will be inserted through your nose into your stomach. The N/G tube will drain secretions from your stomach and it will remain in place for a few days until your bowel function returns to normal.
· A tube called a catheter will be placed in your bladder to drain urine. This will be removed a few days after the operation.
· Three tubes will be placed in your abdomen to drain blood and fluid from around the liver. These will remain in place for about one week.
· In most cases, the surgeon will place a special tube, called a T-tube, in your bile duct. The T-tube will drain bile into a small pouch outside of your body so it can be measured several times daily. Only certain transplant patients receive a T-tube, which remains in place for five months. The tube causes no discomfort and does not interfere with daily activities.
What Complications Are Associated With Liver Transplant?
Two of the most common complications following liver transplant are rejection and infection.
· Rejection. Your immune system works to destroy foreign substances that invade your body. The immune system, however, cannot distinguish between your transplanted liver and unwanted invaders, such as viruses and bacteria. Therefore, your immune system may attempt to attack and destroy your new liver. This is called a rejection episode. About 70% of all liver-transplant patients have some degree of organ rejection prior to discharge. Anti-rejection medications are given to ward off the immune attack.
· Infection. Because anti-rejection drugs that suppress your immune system are needed to prevent the liver from being rejected, you are at increased risk for infections. This problem diminishes as time passes. Not all patients have problems with infections, and most infections can be treated successfully as they occur.
What Are Anti-rejection Medications?
After the liver transplant, you will receive medications called immunosuppressants. These medications slow or suppress your immune system to prevent it from rejecting your new liver. They may include azathioprine (Imuran), Cellcept (mycophenolate mofetil), prednisone (Deltasone, Kedral, Medrol, Orasone, Prelone, Sterapred DS), cyclosporine (Neoral), Prograf (a brand of tacrolimus, also known as FK506), and Rapamune (sirolimus). You must take these drugs exactly as prescribed for the rest of your life.
When Will I Be Able to Go Home After a Liver Transplant?
The average hospital stay after liver transplant is two weeks to three weeks. Some patients may be discharged in less time, while others may be in the hospital much longer, depending on complications that may arise. You need to be prepared for both possibilities.
To provide a smooth transition from hospital to home, the nursing staff and your transplant coordinator will begin to prepare you for discharge shortly after you are transferred from the intensive-care unit to the regular nursing floor. You will be given a discharge manual, which reviews much of what you will need to know before you go home.
You will learn how to take your new medications and how to monitor your own blood pressure and pulse. As you perform these functions regularly, you will become an important participant in your own healthcare. Before your discharge, you will also learn the signs of rejection and infection and will know when it is important to call your doctor.
Readmission after discharge is common, especially within the first year after transplantation. The admission is usually for treatment of a rejection episode or infection.
What Follow-Up Is Necessary After a Liver Transplant?
Your first return appointment after a liver transplant will generally be scheduled about one week to two weeks after discharge. During this visit, you will see the transplant surgeon and transplant coordinator. If needed, a social worker or a member of the psychiatric team may also be available.
All patients return to their transplant hospital approximately five months after the transplant. If a T-tube was inserted during the operation, it will be removed by the transplant surgeon at this time.
All patients are scheduled to return to the hospital at their one-year transplant anniversary date and annually thereafter.
Your primary care doctor should be notified when you receive your transplant and when you are discharged. Though most problems related to the transplant will need to be taken care of at the transplant hospital, your primary care doctor will remain an important part of your medical care.
Waiting list candidates
100,978
as of 03/06/2009
Transplants January - November 2008
25,630
as of 02/27/2009
Donors January - November 2008
12,936
as of 02/27/2009
What Can Be Donated
Organs
Tissue
Stem Cells
Blood
Types of Donation
Organ and Tissue Donation from Living Donors
Donation After Brain Death
Donation After Cardiac Death (DCD)
Whole Body Donation
Who Can Donate
Most People Can Donate
You Are Never Too Old
Medical Condition? — Don't Rule Yourself Out
Who Gets a Liver?The average waiting time for a liver is 796 days. (UNOS/OPTN Annual Report 2003) Candidates who need a liver transplant are given a MELD/PELD score (Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease) that indicates how urgently they need the organ. A liver will be offered to the candidate with a matching tissue type and the highest MELD/PELD score first (the high score indicates the greatest need.) If the first donor’s surgeon does not accept the organ then the liver specialists at UNOS will offer the liver to matched patients according to the MELD/PELD scores until the organ is accepted. Geographic factors are also taken into consideration, but livers can stay healthy outside the body for 12 to 24 hours so the UNOS liver team has greater flexibility than the teams that work with hearts and lungs ( Partnering With Your Transplant Team (PDF) , page 10). See the OPTN/UNOS Allocation of Livers Policy (PDF) for details. To learn more about how MELD/PELD scores are assigned, see the OPTN MELD/PELD calculators
Who Gets a Heart?The average national waiting time for a heart is 230 days. (UNOS/OPTN Annual Report 2003) People waiting for a heart transplant are assigned a status code, which indicates how urgently they need a heart. Because thoracic organs such as the heart and lungs can only survive outside the body for 4 to 6 hours (Partnering With Your Transplant Team (PDF) , page 10), they are given first to people who live near the place where the donor is hospitalized. If no one near the donor is a match for the heart, the transplant team starts searching farther away through a series of zones in a specific sequence. See the OPTN/UNOS Allocation of Thoracic Organs Policy (PDF) for details.
Who Gets a Lung?The average waiting time for a lung is 1,068 days. (UNOS/OPTN Annual Report 2003) The UNOS team divides people waiting for lung transplants into two groups – people who need only one new lung and those who need two. The lung allocation system uses clinical information—including lab values, test results, and disease diagnosis—to estimate the urgency of a candidate’s need for transplant and the likelihood of prolonged survival following the transplant. This lung allocation score, as well as blood group, age, and distance from the donor hospital are considered to determine the order in which a donated lung is offered to candidate recipients. Distance is important because lungs can only survive outside the body for 4 to 6 hours (Partnering With Your Transplant Team (PDF) , page 10); they are offered first to people near the donor. If no one near the donor is a match for the lung, the transplant team starts searching farther away through a series of zones in a specific sequence. A pair of lungs will either be given to one person who needs them both, or divided between two people who need single lung transplants. See the OPTN/UNOS Allocation of Thoracic Organs Policy (PDF) for details.
Who Gets a Kidney?The average waiting time for a kidney is 1,121 days. (UNOS/OPTN Annual Report 2003) When a UNOS team selects possible recipients for a donor kidney, they consider a variety of characteristics of both the donor and the recipient, including tissue match, blood type, blood antibody levels (which show how active the immune system is at the current time – too much activity increases the risk of rejection), length of time on the waiting list, whether the recipient is a child, whether the body sizes of the donor and recipient are a good match, and geographic factors. Kidneys can stay healthy outside the body for between 48 and 72 hours, so the UNOS kidney team can consider many more candidates than the heart or lung teams
Who Gets a Pancreas?The average waiting time for a pancreas is 501 days. (UNOS/OPTN Annual Report 2003) The pancreas can remain healthy outside the body for 12 to 24 hours .A person who is offered a donor pancreas can be selected from people waiting for a pancreas transplant alone, a kidney-pancreas combination transplant, or a combined kidney-pancreas-islet transplant. The Islets of Langerhans are cells inside the pancreas that secrete insulin. They can be transplanted by themselves if the whole organ does not need to be used. An islet transplant is the kind of transplant that is most useful for people with diabetes whose pancreas is healthy but the Islets of Langerhans, do not make insulin. Insulin is needed to break down sugar. People who have had pancreatitis (inflammation of the pancreas) and have damage all through their pancreas need the whole organ. See the OPTN/UNOS Allocation of Pancreas Policy (PDF) for details.
April is National Donate Life Month
30 Days to Help Save a Life: What to Do in April
National Donate Life Month was established in 2003. Every day in April, people across the U.S. make a special effort to celebrate the tremendous generosity of those who have saved lives by becoming organ, tissue, marrow, and blood donors and to encourage more Americans to follow their fine example.
Make it known: I want to be a donor
Register with your State Donor Registry, if available.
Say YES to donation on your driver's license.
Tell your family, friends, physician, and faith leader that you want to be a donor.
Fill out and sign a donor card, have it witnessed, carry it with you.
Tell someone: The need is great and growing.
More than 98,000 people are in need of an organ for transplant.
Each day, about 77 people get the organ transplant that gives them a second chance, but 17 to 19 others die because they did not receive an organ transplant.
More than half the people on the waiting list for a donated organ are racial or ethnic minorities. Chances of getting a transplant increase if donor and recipient share the same racial/ethnic background.
Get involved: Become a donation advocate.
Encourage your company, association, union, or other organizations to which you may belong to join the Workplace Partnership for Life.
Promote and support work site donation campaigns.
Tell your local high school about Decision Donation, a school program that educates students about donation.
Participate in local National Donate Life Month events sponsored by your local organ procurement organization.
From the Mayo Clinic
(http://www.mayoclinic.org/liver-transplant/livingdonorlivertransplant.html):
The number of patients awaiting liver transplantation in the United States greatly exceeds the supply of cadaver donor organs. More than 15,000 patients are currently registered on the liver transplant waiting list of the United Network for Organ Sharing (UNOS), while only about 4,500 cadaver donor livers become available for transplantation each year. Cadaver donor organ availability appears to have reached a plateau despite many initiatives intended to increase organ donation.
The waiting time for liver transplantation has increased steadily each year, rising from approximately one month in 1988 to more than a year in 1999. Currently, more than one-third of patients in the United States wait longer than two years for a liver transplant, and more patients die each year while awaiting transplantation. There is a critical shortage of donor organs, and this problem will continue to worsen in the foreseeable future.
From the USC website
http://www.ucsfhealth.org/adult/medical_services/organ_transplants/liver/liver_donor_transplant_facts.html:
Living Donor Liver Transplant: The Facts
In the United States, there are over 17,000 patients on the liver waiting list, but only enough donated livers to perform about 5,000 transplants per year. As a result, more than 1,700 patients die each year while on liver waiting lists. Technological advances -- along with the liver's unique ability to regenerate itself -- have allowed UCSF Medical Center transplant surgeons to perform living donor liver transplants.
Here are some facts on living donor liver transplantation:
· It began over a decade ago to enable adults to donate part of their liver to children
· In the mid-1990s, countries with limited cadavers began adult-to-adult living donor transplants
· Surgeons at UCSF Medical Center performed their first adult-to-child procedure in 1993 and the first adult-to-adult procedure in January, 2000 Since 2000, UCSF Medical Center has performed more than 90 adult-to-adult transplants
· A living donor doesn't have to be a blood relative, but must have a compatible blood type
· During surgery about 40 percent o 60 percent of the donor's liver is removed
· The average hospital stay for both recipient and donor is seven days; the recovery time for donors is about two months and for recipients is about six to 12 months
· The liver begins to regenerate itself almost immediately
· Within eight weeks, both the donor's and the recipient's livers will be almost completely regenerated
Preparation
In living donor liver transplantation, a piece of liver is removed from a living donor and transplanted into a recipient. The procedure, performed after the diseased liver has been removed, is possible because the liver regenerates or grows. The liver's unique ability to regenerate itself -- combined with technological advances -- allows more people to be donors.
Regeneration happens over a short period, possibly days to weeks and certainly within eight weeks. When surgeons remove a piece of the donor's liver, the part that remains grows back quickly to its original size.
More than a decade ago, surgeons around the world began performing living donor transplants using adult donors for children who needed transplants. Surgeons at UCSF Medical Center have performed these transplants between adults and children since 1992.
Evaluation
Once your blood type is confirmed, you will receive a detailed confidential questionnaire about your family medical history, lifestyle and other information. The evaluation includes a series of tests to check your blood type and overall health. Tests include:
· Chest X-ray
· Electrocardiogram (EKG or ECG)
· Abdominal ultrasound
A doctor who is not a member of the transplant team will complete your medical evaluation and serve as the "donor advocate" doctor throughout your surgery and recovery.
From eMedicineHealth Website
http://www.emedicinehealth.com/liver_transplant/article_em.htm
Liver Transplant Overview
Currently, more than 17,000 people in the United States are waiting for liver transplants. According to the United Network for Organ Sharing (UNOS), about 5,300 liver transplantations were performed in the United States in 2002.
The liver is the second most commonly transplanted major organ, after the kidney, so it is clear that liver disease is a common and serious problem in this country. It is important for liver transplant candidates and their families to understand the basic process involved with liver transplants, to appreciate some of the challenges and complications that face liver transplant recipients (people who receive livers), and to recognize symptoms that should alert recipients to seek medical help.
Some basics are as follows:
The liver donor is the person who gives, or donates, all or part of his or her liver to the waiting patient who needs it. Donors are usually people who have died and wish to donate their organs. Some people, however, donate part of their liver to another person (often a relative) while living.
Orthotopic liver transplantation refers to a procedure in which a failed liver is removed from the patient's body and a healthy donor liver is transplanted into the same location. In this case, the liver donor is someone who has recently died. The procedure is the most common method used to transplant livers.
With a living donor transplant, a healthy person donates part of his or her liver to the recipient. This procedure has been increasingly successful and shows promise as a solution to the shortage of liver donors. It is becoming the most frequent option in children, partly because child-sized livers are in such short supply. Other methods of transplantation are used for people who have potentially reversible liver damage or as temporary measures for those who are awaiting liver transplants. These other methods are not discussed in detail in this article.
The body needs a healthy liver. The liver is an organ located in the right side of the abdomen below the ribs. The liver has many vital functions.
It is a powerhouse that produces varied substances in the body, including (1) glucose, a basic sugar and energy source; (2) proteins, the building blocks for growth; (3) blood-clotting factors, substances that aid in healing wounds; and (4) bile, a fluid stored in the gallbladder and necessary for the absorption of fats and vitamins.
As the largest solid organ in the body, the liver is ideal for storing important substances like vitamins and minerals. It also acts as a filter, removing impurities from the blood. Finally, the liver metabolizes and detoxifies substances ingested by the body. Liver disease occurs when these essential functions are disrupted. Liver transplants are needed when damage to the liver severely impairs a person's health and quality of life.
Determining whose need is most critical: The United Network for Organ Sharing uses measurements of clinical and laboratory problems to divide patients into groups that determine who is in most critical need of a liver transplant. In early 2002, UNOS enacted a major modification to the way in which people were assigned the need for a liver transplant. Previously, patients awaiting livers were ranked as status 1, 2A, 2B, and 3, according to the severity of their current disease. Although the status 1 listing has remained, all other patients are now classified using the Model for End-Stage Liver Disease (MELD) scoring system if they are aged 18 years or older, or the Pediatric End-Stage Liver Disease (PELD) scoring system if they are younger than 18 years. These scoring methods were set up so that donor livers could be distributed to those who need them most urgently.
Status 1 (acute severe disease) is defined as a patient with only recent development of liver disease who is in the intensive care unit of the hospital with a life expectancy without a liver transplant of fewer than 7 days.
MELD scoring: This system is based on the risk or probability of death within 3 months if the patient does not receive a transplant. The MELD score is calculated based only on laboratory data in order to be as objective as possible. The laboratory values used are a patient's creatinine, bilirubin, and international normalized ratio, or INR (a measure of blood-clotting time). A patient's score can range from 6 to 40. In the event of a liver becoming available to 2 patients with the same MELD score and blood type, time on the waiting list becomes the deciding factor.
PELD scoring: This system is based on the risk or probability of death within 3 months if the patient does not receive a transplant. The PELD score is calculated based on laboratory data and growth parameters. The laboratory values used are a patient's albumin, bilirubin, and INR (measure of blood-clotting capability). These values are used together with the patient's degree of growth failure to determine a score that can range from 6 to 40. As with the adult system, if a liver were to become available to two similarly sized patients with the same PELD score and blood type, the child who has been on the waiting list the longest will get the liver.
Based on this system, livers are first offered locally to status 1 patients, then according to patients with the highest MELD or PELD scores. Next, if there are no local recipients, the liver is offered regionally, in the same order, and finally, on a national level.
Status 7 (inactive) is defined as patients who are considered to be temporarily unsuitable for transplantation.
Who may not be given a liver: A person who needs a liver transplant may not qualify for one because of the following reasons:
Active alcohol or substance abuse: Persons with active alcohol or substance abuse problems may continue living the unhealthy lifestyle that contributed to their liver damage. Transplantation would only result in failure of the newly transplanted liver.
Cancer: Cancers in locations other than just the liver weigh against a transplant.
Advanced heart and lung disease: These conditions prevent a transplanted liver from surviving.
Severe infection: Such infections are a threat to a successful procedure.
Massive liver failure: This type of liver failure accompanied by associated brain injury from increased fluid in brain tissue rules against a liver transplant.
HIV infection
The transplantation team: If a liver transplant is recommended by a primary doctor, the person must also be evaluated by a transplantation team. The usual candidate has advanced liver disease but is otherwise in good health.
The transplantation team usually consists of a transplant coordinator, a hepatologist (liver specialist), and a transplant surgeon. It may be necessary to see a cardiologist (heart specialist) and pulmonologist (lung specialist), depending on the recipient's age and health problems.
The potential recipient may also see a psychiatrist because the liver transplantation process may be a very emotional experience that may require life adjustments.
The liver specialist and the primary doctor manage the person's health issues until the time of transplantation.
A social worker may be involved in the case. This person assesses and helps develop the patient's support system, a central group of people on whom the patient can depend throughout the transplantation process. A positive support group is very important to a successful outcome. The support group can be instrumental in ensuring that the patient takes all the required medicines, which may have unpleasant side effects. The social worker also checks to see that the recipient is taking medications appropriately.
The search for a donor: Once a person is accepted for transplantation, the search for a suitable donor begins. All people waiting are placed on a central list at UNOS. Local and national agencies are involved in finding suitable livers. The United States has been divided into regions to try to fairly distribute this scarce resource. Many donors are victims of some sort of trauma and have been declared brain dead. A donor with the right blood type and similar body weight is sought to help reduce the risk of rejection. Rejection occurs when the patient's body attacks the new liver.
With the shortage of donor organs and the need to match donor and patient blood and body type, the waiting time may be long. A patient with a very common blood type has less chance of quickly finding a suitable liver because so many others with his or her blood type also need livers. Such patients are likely to receive a liver only if they are in the intensive care unit and have very severe liver disease. A patient with an uncommon blood type may receive a transplant more quickly if a matching liver is identified because people higher on the transplant list may not have this unusual blood type.
The length of time a person waits for a new liver depends on blood type, body size, and how soon the patient needs a transplant. During the wait, it is important to stay in good physical health. Following a nutritious diet and a light exercise plan are important. In addition, regularly scheduled visits with the transplantation team may be scheduled for health examinations. A patient also receives vaccines against certain bacteria and viruses that are more likely to develop after the transplantation because of immunosuppression (antirejection) medication.
Living donors: Avoiding a long wait is possible if a person with liver disease has a living donor who is willing to donate part of his or her liver. This procedure is known as living donor liver transplantation. The donor must have major abdominal surgery to remove the part of the liver that will become the graft (also called a liver allograft, which is the name for the transplanted piece of liver). As techniques in liver surgery have improved, the risk of death in people who donate a part of their liver has dropped to about 1%. The donated liver will be transplanted into the patient. The amount of liver that is donated will be about 50% of the recipient's current liver size. Within 6-8 weeks, both the donated pieces of liver and the remaining part in the donor grow to normal size.
Until 1999, living donor transplantation was generally considered experimental, but it is now an accepted method. In the future, this procedure will be used more often because of the severe lack of livers from recently deceased donors.
The live donor procedure also allows greater flexibility for the patient because the procedure may be done for people who are in the lower stages of liver disease.
At present, only patients with the most severe liver disease are allowed to receive transplants. These are often patients in intensive care units who have a very short life expectancy, often classified as stage 1, or patients with very high MELD or PELD scores.
With a living donor, patients healthy enough to live at home may still receive a liver transplant. The living donor transplantation may also be more widely used because of the increase in hepatitis C virus infection and the importance of quickly finding transplants for people who have liver cancer. Finally, the success with living donor kidney transplants has encouraged increased use of such techniques.
Recipients of a living donor liver transplant go through the same evaluation process as those receiving a cadaveric liver (a liver from someone who has died). The donor also has blood tests and imaging studies of the liver performed to make sure it is healthy. The living donors, as with the deceased donors, must have the same blood type as the recipient. They must be aged 18-55 years, have a healthy liver, and be able to tolerate the surgery. The donor cannot receive any money or other form of payment for the donation. Finally, the donor must have a good social support system to aid in emotional aspects of going through the procedure.
People who have liver disease or alcoholism are not allowed to donate part of their liver. Those who smoke chronically or who are obese or pregnant also cannot make such donations. If the potential donor does not have a compatible blood type or does not meet these criteria, the recipient may continue to be listed on the UNOS registry for a transplant from a deceased donor.
A donor is found: Once a suitable cadaveric liver donor has been found, the patient is called to the hospital. It is best that the patient carry a beeper as he or she rises on the transplant list, so that getting to the hospital can be done quickly. Donor livers function best if they are transplanted within 8 hours, although they can be used for up to 24 hours. Presurgical studies, including blood tests, urine tests, chest x-rays, and an ECG, are performed. Before surgery, an IV line is started. The patient also receives a dose of steroids-one of the medicines to prevent rejection of the new liver-and a dose of antibiotics to prevent infection. The liver transplantation procedure takes about 6-8 hours. After the transplantation, the patient is admitted to the intensive care unit.
Liver Transplant Causes
Liver disease severe enough to require a liver transplant can come from many causes. Doctors have developed various systems to determine the need for the surgery. Two commonly used methods are by specific disease process or a combination of laboratory abnormalities and clinical conditions that arise from the liver disease. Ultimately, the transplantation team takes into account the type of liver disease, the person's blood test results, and the person's health problems in order to determine who is a suitable candidate for transplantation.
In adults, chronic active hepatitis and cirrhosis (from alcoholism, unknown cause, or biliary) are the most common diseases requiring transplantation. In children, and in adolescents younger than 18 years, the most common reason for liver transplantation is biliary atresia, which is an incomplete development of the bile duct.
Laboratory test values and clinical or health problems are used to determine a person's eligibility for a liver transplant.
For certain clinical reasons, doctors may decide that a person needs a liver transplant. These reasons may be health problems that the person reports, or they may be signs that the doctor notices while examining the potential recipient. These signs usually occur when the liver becomes severely damaged and forms scar tissue, a condition known as cirrhosis. The most common clinical and quality-of-life indication for a liver transplant is ascites, or fluid in the belly due to liver failure. In the early stage of this problem, ascites may be controlled with medicines (diuretics) to increase urine output and with dietary modifications (limiting salt intake). Another serious consequence of liver disease is hepatic encephalopathy. This is mental confusion, drowsiness, and inappropriate behavior due to liver damage. Both ascites and encephalopathy are used in the current classification system to determine the severity of liver disease.
Several other clinical problems may arise from liver disease. Infection in the abdomen, known as bacterial peritonitis, is a life-threatening problem. It occurs when bacteria or other organisms grow in the ascites fluid. Liver disease causes scarring, which makes blood flow through the liver difficult and may increase the blood pressure in one of the major blood vessels that supply it. This process may result in serious bleeding. Blood may also back up into the spleen and cause it to increase in size and to destroy blood cells. Blood may also go to the stomach and esophagus (swallowing tube). The veins in those areas may grow and are known as varices. Sometimes, the veins bleed and may require a gastroenterologist to pass a scope down a person's throat to evaluate them and to stop them from bleeding. These problems may become very difficult to control with medicines and can be a serious threat to life. A liver transplant may be the next step recommended by the doctor.
From WebMD:
Liver Transplantation
The liver is the body's largest internal organ, weighing about 3 pounds in adults. It is located below the diaphragm on the right side of the abdomen.
The liver performs many complex functions in the body, including:
· Produces most proteins needed by the body.
· Metabolizes, or breaks down, nutrients from food to produce energy, when needed.
· Prevents shortages of nutrients by storing certain vitamins, minerals and sugar.
· Produces bile, a compound needed to digest fat and to absorb vitamins A, D, E and K.
· Produces most of the substances that regulate blood clotting.
· Helps your body fight infection by removing bacteria from the blood.
· Removes potentially toxic byproducts of certain medications.
When Is a Liver Transplant Needed?
Liver transplantation is considered when the liver no longer functions adequately (liver failure). Liver failure can occur suddenly (acute liver failure) as a result of infection or complications from certain medications or it can be the end result of a long-term problem. The following conditions may result in liver failure:
· Chronic hepatitis with cirrhosis.
· Primary biliary cirrhosis (a rare condition where the immune system inappropriately attacks and destroys the bile ducts causing liver failure).
· Sclerosing cholangitis (scarring and narrowing of the bile ducts inside and outside of the liver causing the backup of bile in the liver which can lead to liver failure).
· Biliary atresia (malformation of the bile ducts).
· Alcoholism.
· Wilson's disease (a rare inherited disease with abnormal deposition of copper throughout the body, including the liver, causing it to fail).
· Hemochromatosis (a common inherited disease where the body is overwhelmed with iron).
· Alpha-1 antitrypsin deficiency (an abnormal accumulation of alpha-1 antitrypsin protein in the liver, resulting in cirrhosis).
· Liver cancer.
How Are Candidates for Liver Transplant Determined?
Evaluations by specialists from a variety of fields are needed to determine if a liver transplant is appropriate. The evaluation includes a review of your medical history and a variety of tests. Many healthcare facilities offer an interdisciplinary approach to evaluate and to select candidates for liver transplantation. This interdisciplinary healthcare team may include the following professionals:
· Liver specialist (hepatologist).
· Transplant surgeons.
· Transplant coordinator, usually a registered nurse who specializes in the care of liver-transplant patients (this person will be your primary contact with the transplant team).
· Social worker to discuss your support network of family and friends, employment history, and financial needs.
· Psychiatrist to help you deal with issues, such as anxiety and depression, which may accompany the liver transplantation.
· Anesthesiologist to discuss potential anesthesia risks.
· Chemical dependency specialist to aid those with history of alcohol or drug abuse.
· Financial counselor to act as a liaison between a patient and his or her insurance companies.
Which Tests Are Required Before Getting a Liver Transplant?
You will need to bring all of your previous doctor records, X-rays, liver biopsy slides and a record of medications to your pre-evaluation for a liver transplant. To complement and to update previous tests, some or all of the following diagnostic studies are generally performed during your evaluation.
· Computed tomography, which uses X-rays and a computer to generate pictures of the liver, showing its size and shape.
· Doppler ultrasound to determine if the blood vessels to and from your liver are open.
· Echocardiogram to help evaluate your heart.
· Pulmonary function studies to determine your lungs' ability to exchange oxygen and carbon dioxide.
· Blood tests to determine blood type, clotting ability, and biochemical status of blood and to gauge liver function. AIDS testing and hepatitis screening are also included.
If specific problems are identified, additional tests may be ordered.
How Does the Liver Transplant Waiting List Work?
If you become an active liver transplant candidate, your name will be placed on a waiting list. Patients are listed according to blood type, body size, and medical condition (how ill they are). Each patient is given a priority score based on three simple blood tests (creatinine, bilirubin, and INR). The score is known as the MELD (model of end stage liver disease) score in adults and PELD (pediatric end stage liver disease) in children.
Patients with the highest scores are transplanted first. As they become more ill, their scores will increase and therefore their priority for transplant increases, allowing for the sickest patients to be transplanted first. A small group of patients who are critically ill from acute liver disease have the highest priority on the waiting list.
It is impossible to predict how long a patient will wait for a liver to become available. Your transplant coordinator is always available to discuss where you are on the waiting list.
Where Does a Liver for a Transplant Come From?
There are two types of liver transplant options: living donor transplant and deceased donor transplant.
· Living donor. Living donor liver transplants are an option for some patients with end-stage liver disease. This involves removing a segment of liver from a healthy living donor and implanting it into a recipient. Both the donor and recipient liver segments will grow to normal size in a few weeks.
The donor, who may be a blood relative, spouse, or friend, will have extensive medical and psychological evaluations to ensure the lowest possible risk. Blood type and body size are critical factors in determining who is an appropriate donor.
Recipients for the living donor transplant must be active on the transplant waiting list. Their health must also be stable enough to undergo transplantation with excellent chances of success.
· Deceased Donor. In deceased donor liver transplant, the donor may be a victim of an accident or head injury. The donor's heart is still beating, but the brain has stopped functioning. Such a person is considered legally dead, because his or her brain has permanently and irreversibly stopped working. At this point, the donor is usually in an intensive-care unit.
The identity of a deceased donor and circumstances surrounding the person's death are kept confidential.
Screening for Liver Transplant Donors
Hospitals will evaluate all potential liver transplant donors for evidence of liver disease, alcohol or drug abuse, cancer, or infection. Donors will also be tested for hepatitis, AIDS, and other infections. If this screening does not reveal problems with the liver, donors and recipients are matched according to blood type and body size. Age, race, and sex are not considered.
The transplant team will discuss your transplantation options with you at the time of your pre-transplant evaluation, or you can contact the transplant team for more information.
What Happens When They Find Liver Transplant Match?
When a liver has been identified for you, a transplant coordinator will contact you by telephone or by pager. Make sure that you do not eat or drink anything once you have been called to the hospital. The transplant coordinator will notify you of any additional instructions. When you arrive at the hospital, additional blood tests, an electrocardiogram, and a chest X-ray will generally be taken before the operation. You also may meet with the anesthesiologist and a surgical resident. If the donor liver is found to be acceptable you will proceed with the transplant. If not, you will be sent home to continue waiting.
What Happens During the Liver Transplant Operation?
Liver transplants usually take from six hours to 12 hours. During the operation, surgeons will remove your liver and will replace it with the donor liver. Because a transplant operation is a major procedure, surgeons will need to place several tubes in your body. These tubes are necessary to help your body carry out certain functions during the operation and for a few days afterward.
Tube Placement
· A tube will be placed through your mouth into your windpipe (trachea) to help you breathe during the liver transplant operation and for the first day or two following the operation. The tube is attached to a ventilator that will expand your lungs mechanically.
· A nasogastric (N/G) tube will be inserted through your nose into your stomach. The N/G tube will drain secretions from your stomach and it will remain in place for a few days until your bowel function returns to normal.
· A tube called a catheter will be placed in your bladder to drain urine. This will be removed a few days after the operation.
· Three tubes will be placed in your abdomen to drain blood and fluid from around the liver. These will remain in place for about one week.
· In most cases, the surgeon will place a special tube, called a T-tube, in your bile duct. The T-tube will drain bile into a small pouch outside of your body so it can be measured several times daily. Only certain transplant patients receive a T-tube, which remains in place for five months. The tube causes no discomfort and does not interfere with daily activities.
What Complications Are Associated With Liver Transplant?
Two of the most common complications following liver transplant are rejection and infection.
· Rejection. Your immune system works to destroy foreign substances that invade your body. The immune system, however, cannot distinguish between your transplanted liver and unwanted invaders, such as viruses and bacteria. Therefore, your immune system may attempt to attack and destroy your new liver. This is called a rejection episode. About 70% of all liver-transplant patients have some degree of organ rejection prior to discharge. Anti-rejection medications are given to ward off the immune attack.
· Infection. Because anti-rejection drugs that suppress your immune system are needed to prevent the liver from being rejected, you are at increased risk for infections. This problem diminishes as time passes. Not all patients have problems with infections, and most infections can be treated successfully as they occur.
What Are Anti-rejection Medications?
After the liver transplant, you will receive medications called immunosuppressants. These medications slow or suppress your immune system to prevent it from rejecting your new liver. They may include azathioprine (Imuran), Cellcept (mycophenolate mofetil), prednisone (Deltasone, Kedral, Medrol, Orasone, Prelone, Sterapred DS), cyclosporine (Neoral), Prograf (a brand of tacrolimus, also known as FK506), and Rapamune (sirolimus). You must take these drugs exactly as prescribed for the rest of your life.
When Will I Be Able to Go Home After a Liver Transplant?
The average hospital stay after liver transplant is two weeks to three weeks. Some patients may be discharged in less time, while others may be in the hospital much longer, depending on complications that may arise. You need to be prepared for both possibilities.
To provide a smooth transition from hospital to home, the nursing staff and your transplant coordinator will begin to prepare you for discharge shortly after you are transferred from the intensive-care unit to the regular nursing floor. You will be given a discharge manual, which reviews much of what you will need to know before you go home.
You will learn how to take your new medications and how to monitor your own blood pressure and pulse. As you perform these functions regularly, you will become an important participant in your own healthcare. Before your discharge, you will also learn the signs of rejection and infection and will know when it is important to call your doctor.
Readmission after discharge is common, especially within the first year after transplantation. The admission is usually for treatment of a rejection episode or infection.
What Follow-Up Is Necessary After a Liver Transplant?
Your first return appointment after a liver transplant will generally be scheduled about one week to two weeks after discharge. During this visit, you will see the transplant surgeon and transplant coordinator. If needed, a social worker or a member of the psychiatric team may also be available.
All patients return to their transplant hospital approximately five months after the transplant. If a T-tube was inserted during the operation, it will be removed by the transplant surgeon at this time.
All patients are scheduled to return to the hospital at their one-year transplant anniversary date and annually thereafter.
Your primary care doctor should be notified when you receive your transplant and when you are discharged. Though most problems related to the transplant will need to be taken care of at the transplant hospital, your primary care doctor will remain an important part of your medical care.
Brian Rx
This blog has been created to keep people up to date on the health of Dr. Brian Buckley, as well as passing on information on fundraising efforts & the search for a liver transplant.
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