When a Liver Becomes Available

When a liver becomes available for your liver transplant, the liver transplant coordinator will attempt to contact you at home. If you are not available, we will page you. When you are paged, please call the paging operator at 513-584-7243. Please identify yourself as a liver transplant patient and ask for the liver transplant coordinator on call. The coordinator is responsible for scheduling transplant surgery. Sometimes pagers are accidentally mis-dialed and the pager will go off. The transplant coordinator will know if you have been paged for surgery or if the pager just went off accidentally.

In preparation for the transplant, have your suitcases packed and travel plans made so that you can leave your house soon after you have been notified that a liver is available for you. You will be asked not to eat or drink anything except for some medications before you come to the hospital. Discuss your medication needs with the coordinator when he/she calls you.

Remember to shower before coming to the hospital. Consider bringing comfortable clothes like sweat suits, so you can wear your own clothes during your recovery in the hospital. Remember to bring your glasses, hearing aides or other items necessary to help you read and learn during your education sessions after transplant. You are welcome to bring a tape recorder to record your education sessions. If you have blood pressure equipment or a home glucose meter, remember to bring these with you also.

You will be instructed to come to the transplant floor immediately. The nursing personnel there will be expecting you. Please bring someone with you. Do not bring a lot of personal possessions or valuables. You will only be in your room for a short period of time. After surgery, you will be going to the Surgical Intensive Care Unit (SICU). Possessions may be lost or misplaced during this time. All valuables/possessions should be given to your family prior to your leaving your room.

When you are initially contacted for your transplant, you will be told that there is always the possibility that you may be prepared for surgery and the surgery may be canceled. This is because there may be a problem with the donor liver, making it unsuitable for you. If this is the case, your surgery will be canceled, and you will be sent home.

The Transplant Surgery

The transplant resident will obtain a history and give you a physical examination before your surgery. Blood and urine tests, an EKG and a chest x-ray will also be done.

You will be asked to sign a consent form for the removal of your liver, possible splenectomy and the actual liver transplant. A special IV will be started in a large vein in your neck for antibiotics and other medications and fluids and to monitor your blood pressure. If your blood tests show clotting problems, you will receive blood products before you go to surgery. Any significant medical problem may result in the cancellation of surgery.

When you are taken to the operating room, your family should wait for you in the Surgical ICU waiting room. The operating room nurses will give periodic updates during your surgery. You will be in surgery for 12 - 18 hours, some of which is preparation time while the rest is the actual operation. The surgeon will talk to your family when the surgery is over. After the surgery, you will go directly to the Surgical ICU. Your family can visit you about an hour after you arrive there.

The Operation

Once you have received general anesthesia and are asleep, the surgeons begin the operation by making an incision in your abdomen. First, your diseased liver will be removed. While the blood vessels are clamped, the blood is directed to your heart using a perfusion machine and partial bypass method. The new liver is inserted and the major vessels are stitched together, revascularizing the new liver. Although this may sounds like a simple process, the operation can be prolonged by scar tissue from previous surgery and/or the amount of bleeding that occurs. Many transplants are now done using the "piggyback" method where bypass is not required.

The bile ducts of the donor liver are then attached to your bile duct or directly to your intestines. To assist in the drainage of the biliary system, a T-tube is occasionally inserted in the bile duct.

If your spleen is going to be removed, you will usually know before going into surgery. Sometimes, however, the doctor makes that decision during the operation.

These and other aspects of your surgery will be discussed with you by the physician and reinforced during your education sessions. Explanations of incision care and tube care will also be discussed during these sessions.