Pretransplantation Evaluation
Prior to transplantation, the team carefully manages chronically ill patients, which contributes to enhanced recovery rates following transplantation. The result is a marked decrease in hospital length of stay without compromising survival rates
Patients who may benefit from liver transplantation should be referred as early as possible, because the waiting time for a liver transplant may be two to three years in the Bay Area. Patient selection depends on a number of factors and contraindications for liver transplantation.
All referrals for consideration of adult liver transplantation at Stanford are assigned to a liver transplant nurse coordinator who organizes the pretransplant evaluation process.
Evaluation generally takes place on an outpatient basis, and involves the following:
- Collection of all appropriate demographic information.
- Financial clearance by the payor.
- Consultations with the transplant hepatologist, social worker, and other physicians as appropriate.
- All prior medical records are retrieved and reviewed as part of this process.
- Any patient with a history of alcohol and substance abuse, or documented or suspected psychiatric disorder, is also seen by a designated liver 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 specialists.
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 make a final decision to list, defer, or decline the patient.
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 as described above.We also see patients in regular liver transplant clinics in concert with the referral physician, with the frequency of appointments at Stanford determined according to the severity of illness and need for special expertise.
Patient status on the waiting list is changed according to disease severity as the patient is followed. If hospitalizations are necessary, the transplant hepatologist together with the referral physician decides the necessity of referral to Stanford Hospital & Clinics versus local care at the referring hospital.