Accepted for a Liver Transplant
If you and the transplant team decide that transplantation is the best treatment for you, you will be listed with the United Network for Organ Sharing (UNOS). UNOS administers and maintains the computerized national organ transplant waiting list. You will join a list of people waiting for a liver donation from a deceased donor.
The New England Organ Bank (NEOB) is the local (regional) organ procurement organization (OPO) for Beth Israel Deaconess Medical Center and the rest of New England, and coordinates sharing organs through UNOS. Staff at NEOB will enter your medical information into a computer and will notify our transplant team when an organ becomes available based on your MELD score (which measures the severity of your liver disease), waiting time on the list, blood type and size match.
For more about wait time, and other statistics, visit The Scientific Registry of Transplant Recipients. The SRTR publishes center-specific reports with a wide range of useful information about transplant programs operating in the United States. The information includes many features of the BIDMC transplant program, such as the number of transplants performed in recent years, waiting time and waitlist outcomes, and the post-transplant experience of our patients. The statistics allow comparisons to national averages, as well as to the experience for similar patients at other centers in the country. The waitlist report is based on BIDMC data for patients transplanted within the last five years..
UNOS has prepared a special brochure describing all that is involved with multiple listings, including completing an evaluation at each program, and checking with your insurance provider to be sure any additional evaluation costs are covered.
You can reach UNOS toll free at 888-894-6361.
Our goal is to work with you to keep you as healthy as possible. During your regular visit to the Transplant Institute we will screen for and treat any new complications, and if necessary, adjust your place on the waiting list according to your MELD score.
The United Network for Organ Sharing (UNOS) has developed an objective way of scoring the severity of a patient's liver disease to predict who needs a liver transplant most urgently. Called the MELD score, which stands for Model for End-Stage Liver Disease, it takes into account three specific laboratory measurements:
- Serum creatinine (measure of kidney function)
- Serum bilirubin (measure of liver function)
- INR (measure of clotting function)
UNOS uses a statistical formula based on these three routine laboratory tests to compute the MELD score, which predicts a patient's risk of dying while on the waiting list. The higher the numerical score, the more urgent the patient's need is for transplantation. This score is then used to prioritize the organ waiting list so that the sickest people are transplanted first.
The MELD score's numerical scale ranges from 6 (patients who are less ill) to 40 (patients who are gravely ill). A patient's MELD score can change a number of times, based on the progression of his or her liver disease. Research has shown that the MELD formula, which is a simple and objective measurement, is a consistently accurate prediction of patients' short-term mortality risk without a transplant.
UNOS and your transplant team can provide you with more information about the MELD score, including how waiting time is counted when your MELD score fluctuates
Hepatic encephalopathy
Patients can experience a state of semi-consciousness when their diseased liver is not able to remove everyday toxins that build up in the bloodstream. Some people with encephalopathy become very confused and/or sleepy, and are unable to care for themselves.
Bleeding varices and ascites (fluid retention)
Portal hypertension is a common complication of cirrhosis. It results when scar tissue prevents the vein that drains blood from the spleen and intestines (portal vein) from bringing the blood through the liver. This condition creates increased pressure in the veins, which can lead to other problems, such as fluid buildup (ascites) in the abdomen and elsewhere, and enlarged veins (varices) in the esophagus or stomach that can bleed.
Spontaneous bacterial peritonitis
This condition is an acute bacterial infection from fluid that has accumulated in the abdomen. It is a very serious complication of end-stage liver disease.
Coagulopathy
This defect in the body's blood clotting process, due to end-stage liver disease, can lead to excessively dangerous bleeding.
Hepatorenal syndrome
Sometimes liver failure can result in a significant decrease in blood flow to the kidneys and cause kidney failure, or hepatorenal syndrome, in certain patients. This syndrome is a very serious complication of liver cirrhosis and only occurs in patients with severe liver injury and significant ascites (fluid buildup).
Emotional Checkups
During your visits to the Transplant Institute, our social worker and psychologist will monitor your emotional well-being very closely. We know that behavioral health issues, such as depression and anxiety, can impact quality of life as well as survival after transplantation. A positive outlook is critical for successful surgery, recovery and overall good health.
Identify a Health Care Proxy
After you are accepted as an organ transplant recipient, you should select a health care proxy if you have not already done so.
In Massachusetts, you can name a person to help you make decisions about your health care if your doctor determines you are unable to express your own wishes. The person is called a health care proxy (or a health care agent). Having a health care proxy ensures that you will receive care that respects your wishes and values.
Even if you have a living will, you should also have a health care proxy. Only a health care proxy is formally recognized by Massachusetts law. Generally, a living will details a person's preferences about the use of life-sustaining medical treatments in the event of terminal illness. But a living will does not anticipate all of the complex medical choices that you may face. Nor does a living will identify a person to speak on your behalf.
Also a health care proxy, unlike a living will, is not limited to situations of terminal illness. It enables you to designate someone who can communicate your values and preferences, and who will make sure caregivers follow your wishes.
Please ask your transplant team if you need a copy of the Massachusetts Health Care Proxy form.
Update Your Insurance
We can help you review your insurance policy to be sure it covers the costs of transplant care (including doctor visits, hospital stays, medications and medical tests).
As your treatment progresses, be sure to keep your insurance up-to-date so all of your information is current and accurate. Our social workers and financial coordinator will help you throughout this process.
Support Group
Once you have been listed for a liver transplant, we invite you to join our weekly Transplant Institute Support Group. This group meets every Wednesday on Farr 10 (the Transplant Inpatient Floor) from 12pm to 12:50 p.m. In the support group you can meet patients who are awaiting transplant and patients who have been transplanted. It will also allow you to visit the inpatient unit, and meet the nurses and staff, who will care for you while you recover from your transplant surgery.