Starting the Process

Patients who may benefit from liver transplantation should be referred as early as possible, because the waiting time for a liver transplant in the Bay Area can be lengthy. All referrals for consideration of adult liver transplantation at Stanford are assigned to a liver transplant nurse coordinator who organizes the pre-transplant evaluation process and teaching session.

Evaluation generally takes place on an outpatient basis and involves the following:

• Collection of all appropriate patient information
• Approval of health insurance coverage
• Consultations with a transplant hepatologist and other doctors, as needed
• Meeting with a transplant social worker. Your support person must attend this appointment
• Review of all prior medical records
• Laboratory studies (blood and urine tests) and radiological studies (X-ray, EKG, CT or MRI)
• Additional tests, depending on your condition and medical history

In some cases, patients with a history of alcohol or substance abuse, or a psychiatric disorder, may be referred to the transplant psychiatrist. Patients with potential technical problems surrounding transplantation are evaluated by a liver transplant surgeon.

Patients with other health problems, such as heart disease, are seen by a cardiologist or other appropriate specialist. Those with chronic kidney disease are also evaluated for dual liver-kidney transplantation.

Patient selection

Patients are then reviewed at a weekly Liver Transplant Selection Committee. Stanford clinicians review the results of all pertinent laboratory and radiologic tests and consultations. Then, a liver transplant selection committee will make a final decision to list, defer, or decline the patient. Patients are notified of the decision by their transplant coordinator. Those declined for liver transplantation at our program are encouraged to apply at other transplant centers.

The Liver Transplant Selection Committee follows the guidelines established by the United Network for Organ Sharing (UNOS) and lists only patients who meet minimal listing criteria.

Patient status on the waiting list is changed according to disease severity as the patient is followed. If hospitalizations are necessary, the transplant hepatologist and the referring physician will decide if it is best for the patient to be admitted at Stanford Hospital or another local hospital.