A team of liver transplant specialists will assess you to see if a liver transplant will be a safe and effective treatment for you. The process can vary between liver transplant centres but it will involve having a number of tests over about 2 days. The assessment checks if you are well enough to have the operation, and if it will improve your condition. It also helps your team work out how soon you need a transplant if you are approved.
You may be admitted to hospital to have these tests as an inpatient (where you stay in hospital throughout the process) or you may be able to have them as an outpatient. This means you stay at home but come into hospital for appointments to have the tests.
A multidisciplinary team (MDT) of specialists will assess the results of your assessment tests to make a decision. The team may include surgeons, hepatologists (specialist liver doctors), anaesthetists, intensive care specialists, liver transplant coordinators, a dietician, social worker and a psychiatrist or specialist addictions nurse.
You’ll have a number of tests to help your doctors decide if you are able to have a liver transplant. These will assess your liver and general health and find out whether your body can cope with the operation, and whether a transplant is the best option for you. Your doctors will also assess your mental health because a liver transplant is major surgery that you need to be able to cope with both physically and mentally.
Blood tests will check your general health and find out if there’s anything that could cause a problem with a liver transplant. For example, you’ll be screened for a range of viruses, including human T-lymphotropic virus (HTLV) and hepatitis. If you have an infection, this may need to be treated or clear before you can be considered for a liver transplant.
You may need to have a number of samples taken (usually up to 12).
A chest X-ray will allow your doctors to see if your heart and lungs are working well and you’re fit enough to have an operation.
Lung function tests, such as a spirometry, will show if your lungs are working well enough to have the operation. In a spirometry, you’ll blow into a device to measure how much air you can breathe out in one forced breath.
An ECG can check the health of your heart and if there are any problems. A clinician will attach leads to your chest, arms and legs, which are connected to a machine that measures the electrical activity in your heart.
You’ll have some tests to see how physically fit you are and how well your heart copes when it has to work hard, like during the operation. Make sure on the day of your test that you wear something you can move in that won’t restrict you.
Different centres test this in different ways, for example you might be asked to cycle as hard as you can on an exercise bike. Or they may ask you to climb some stairs. You might do the fitness test while having your heart monitored, for example, with an ECHO (see below).
You want to push yourself as hard as you can on this test but don’t worry, just do your best. It’s a good idea to practice while you are waiting for your assessment by doing some physical activity every day.
An echocardiogram (ECHO) will check the size of your heart and how well it pumps blood to see if there are any problems. A clinician will move a probe over your heart area to send sound waves through your skin, which are reflected and sent to a computer that turns them into pictures.
In an ECHO and cardiopulmonary exercise test (CPET), you’ll do some vigorous activity, such as a session on an exercise bike while having the test. This is so your doctors can compare your heart action when it’s working hard, to when it’s at rest. You may need this test if you have risk factors for heart disease, or are over 50.
You may need to give samples of blood and urine to check how well your kidneys are working. Kidney problems are a common if you have liver disease.
You may need a coronary angiography if you have coronary disease. It will help your doctors understand how healthy your arteries are and whether there are any problems that could make a liver transplant too risky. A doctor will inject a dye into your arteries and take an X-ray.
You’ll have computerised tomography (CT) or magnetic resonance imaging (MRI) scans. These will give detailed images of the inside of your body, including your liver, which will help to check everything looks right for surgery or if there are any potential problems. If you have liver cancer, scans will check where it is, and if it has spread out of your liver.
You may also have an ultrasound to check the condition of the blood vessels going to your liver to make sure the surgery can go ahead. A clinician will move a probe over your liver to send sound waves through your skin, which are reflected and sent to a computer to turn into pictures.
An endoscopy can find out whether the tiny veins in your food pipe (oesophagus) and stomach are damaged or bleeding (variceal bleeding). During an endoscopy, your doctor will pass a very thin tube with a tiny camera down your throat and into your stomach, usually under local anaesthetic, so you won’t feel any pain.
A psychologist, psychiatrist or addictions nurse specialist will ask you questions about your health and life, including if you take drugs or drink alcohol, and how much. It’s important to answer all the questions as truthfully and fully as possible.
The purpose of the assessment isn’t to test you and there aren’t any right or wrong answers. The team will only want to understand your individual circumstances so they can offer you the support you need to give you the best chance of having a successful liver transplant.
Psychological assessment will also make sure that you’ll be able to cope and adjust to life after your operation. For example, you’ll need to remember to take medicines for the rest of your life and attend regular healthcare appointments.
Support is an essential part of the transplant process. Your transplant team will need to make sure that you have this in place before you’re considered for a liver transplant. If you’d like a family member or carer to be involved in your liver assessment, your transplant team will ensure they feel included in the conversation. They may hold online education events for patients and their family and carers, for example.
Let your transplant team know if any of you have any questions or concerns. Transplant units have services available to help you. While these can vary by centre they usually include:
- Social workers
- Occupational therapists
When you go to hospital for a liver assessment, whether as an inpatient or outpatient, take along any medicines you’re currently taking, and any written communication about your liver disease or previous test results. If you have any other conditions, it’s a good idea to bring any medicines you take or information from your doctor. Bring anything that will help you answer questions about your health.
If you’re having your tests in hospital as an inpatient, make sure you have everything you’ll need for about 2 days.
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After all the tests are complete, which will usually take around 2 days, a multidisciplinary team (MDT) of specialists will meet to decide whether a liver transplant is the best treatment option for you. You will usually have your decision within a week and it will fall into one of the following categories:
- You will be put on the waiting list for a transplant.
- You need a transplant but need to have more tests to make sure it will be safe. You’ll get a final decision after these tests are done, which is usually after a few weeks but it will depend on the type of test.
- A liver transplant isn’t suitable for you right now. You may have some other form of treatment first and see if you improve, or you may need to work on your fitness or change your alcohol or drug use. You can then be assessed again, usually in a few weeks.
- A liver transplant isn’t an option for you, which your transplant team will explain.
The transplant assessment must show that your life expectancy with a liver transplant will be more than your life expectancy without one, and that you’ll have a better quality of life.
If you’re eligible for a liver transplant
If the transplant team decide you’re suitable for a liver transplant and need one soon, they’ll ask if you want to be placed on the waiting list. This is a list of everyone in your local area who needs a liver transplant and donors are matched to these.
If you’re well enough, you can stay at home while you wait to be matched to a donor. Be prepared to get a call at any time to say that a liver is available. You’ll then need to go into the liver transplant unit and may have your operation.
Your options if you’re not eligible
If you are not approved for a liver transplant, your transplant team will ask you:
• to have regular check-ups to monitor your condition – the assessment can be repeated if your condition changes
• if you want a second opinion – another transplant team can do an assessment to see if they agree with the original decision
Depending on your health and the liver condition you have, there may be treatments to help control your symptoms. And there are people you can talk to, to support you and help you going forward.
For more information about what to do if you’re not approved for a liver transplant, including emotional support, read our information on thinking ahead.