The Liver Transplant Journey at Hopkins
Entering the Hopkins System
The Transplant Evaluation
The Waiting List
The Surgery
After the Transplant
Entering the Hopkins System
Patients who come to Johns Hopkins receive a thorough evaluation by leading experts in liver disease. Some patients will move immediately toward liver transplantation. Others will be able to manage their condition well for months or years before transplantation becomes necessary.
Hopkins sees patients as people with complicated illnesses, for which transplantation may be one among several treatment options.
Patients can enjoy the utmost in comfort and privacy by reserving, for an additional charge, a hospital room in Hopkins’ Marburg Pavilion, following the most acute phase of their transplant. This beautiful unit provides the technical sophistication of a hospital facility with the comfort and amenities of a five-star hotel.
The Transplant Evaluation
During the transplant evaluation, candidates meet with a team of experts who will be with them throughout the transplant process. A battery of tests may require two to three visits to The Johns Hopkins Hospital. The tests may include routine blood work, an X-ray of heart and lungs, an abdominal ultrasound, a CT scan, pulmonary function tests, an electrocardiogram and an echocardiogram. Specialists from the transplant team—surgeons, hepatologists, pulmonologists, anesthesiologists, cardiologists, psychologists, nurses and social workers—are consulted.
The Waiting List
After being approved for transplantation, patients are immediately put on the United Network for Organ Sharing (UNOS) waiting list. The waiting time for a liver can vary from up to several days to years, depending on the patient’s condition. A point system based on the severity of illness determines who will receive a donated liver.
Called MELD (model for end-stage liver disease) and PELD (pediatric end-stage liver disease) scores, the system assigns each individual a score based on how urgently he or she needs a liver transplant. Laboratory blood tests, including creatinine, albumin and protrohrombin time, are calculated into a standard formula that uses the height, weight and age of a patient to calculate a weighted score for an individual. It is therefore important to evaluate patients early in the course of their liver disease so that this score can be monitored, as it could change rapidly and affect a patient’s waiting time for a cadaveric liver. All patients on the list are treated equally and evaluated objectively.
The Surgery
Patients awaiting a cadaveric organ may be called at any time. When the call comes, patients proceed to the Emergency Acute Care Unit to prepare for surgery.
For living donors and recipients, the surgery can be planned. They are asked to come to a preoperative care area the morning of surgery.
The surgery can take from 6 to 12 hours, depending on the patient’s medical condition and previous surgeries. After surgery, the patient goes to the surgical intensive care unit (SICU), usually for 24 to 48 hours. The expected length of hospital stay for an uncomplicated liver transplant is 7 days.
After the Transplant
The transplant team, including surgeons, hepatologists, gastroenterologists, nurses, dietitians and social workers, follows transplant recipients throughout their recovery. The team fully prepares patients for discharge from the hospital by conducting one-on-one education sessions and providing them with some helpful reminders and information who to contact with additional questions once they are at home.
Patients are seen as needed in the outpatient clinic. Arrangements can be made for blood drawing and medication management through patients’ primary care physicians. Partnering with community physicians is an important part of the transition.
