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​​​​​Referral and Pre-Transplant Process

Referral Process

The referral process begins when a member of the pre-transplant evaluation team receives a call from a patient's physician. A pre-transplant coordinator will then conduct a basic medical history by phone. The patient's medical chart and insurance information is sent to the transplant center for review. If no major contraindications are found, the patient proceeds to the transplant center for an evaluation.

This comprehensive medical evaluation is required in order to determine the extent of the patient's liver disease. The evaluation takes four to five days and is usually done on an outpatient basis. Depending on the severity of the illness, some patients require hospitalization during their evaluation.

Evaluation

Pre-Transplant evaluation testing and consultation includes:

  • MRI (Magnetic Resonance Imaging)
  • Ultrasound (Sonogram)
  • Cardiac Stress Test
  • Glofil or 24-Hour Urine for Creatinine Clearance
  • Echocardiogram
  • Electrocardiogram (EKG, ECG)
  • Hepatologist or Gastroenterologist Consult
  • Transplant Surgeon Consult
  • Psychosocial Evaluation
  • Nutritional Evaluation
  • Financial Meeting

Additional Tests and Consults are Scheduled as needed and may include:

  • Bone Scans
  • Skeletal Survey
  • MUGA Scan
  • CT Scan
  • Liver Biopsy
  • Arteriogram (Angiogram)
  • Pulmonary Function Test
  • Endoscopy
  • Hepatobiliary Scan
  • Sclerotherapy
  • Banding/Endoscopic Variceal Ligation
  • Cholangiogram
  • ERCP
  • Colonoscopy

Possible liver transplant disqualifiers:

  • Metastatic (spreading) malignancy of the liver or other primary malignancy
  • Other serious diseases, such as infection, heart disease, or lung disease
  • History of noncompliance with your medical regimen
  • Inadequate support from family or friends
  • Alcohol or other chemical abuse

Patient Selection

Upon completion of the pre-evaluation tests, potential candidates are evaluated by the Patient Selection Committee. The Patient Selection Committee is comprised of physicians and consultants from various specialties, social workers, nurse coordinators, and dietitian. In addition to the medical suitability, a candidate must be considered an acceptable surgical risk, must be reliable and compliant, and must have an adequate support system to help the patient adhere to the required post-transplant treatment program. Once the selection committee confirms a patient is a viable medical candidate, Baylor works with a patient's insurance company to obtain financial clearance.

Waiting List and MELD​

Once a patient has been accepted as a transplant candidate, he/she is placed on the United Network for Organ Sharing (UNOS) waiting list. Each transplant center is required to continuously monitor changes in a patient's condition, which directly affect their placement on the waiting list and their priority for transplant.

The placement on the list is determined by the patient's MELD score (Model for End-Stage Liver Disease), which uses specific lab values to determine the severity of illness. Based on the clinical data, patients with higher scores (between 1 and 40) will be given higher priority on the waiting list. Each MELD score requires lab results to be submitted to UNOS within a certain time period (ranging from every 7 days to once a year) or the MELD score will be automatically lowered and the patient downgraded on the waiting list.​