When to Refer a Patient for Liver Transplant

Patients may be referred to the Transplant Center at Carolinas Medical Center for consideration by their gastroenterologist, primary care physician, hepatologist or insurance carrier.

Referral information should include the following:

• Patient demographic information
• Insurance information (copies of the front and back of insurance cards)
• Medical records, including blood work, radiology and pathology studies

Evaluation Process

The intake team reviews all referrals and contacts your patient. The patient's information also is forwarded to a transplant financial coordinator to verify transplant coverage.

Once authorization for the evaluation is obtained from the insurance company, the patient is scheduled for an outpatient evaluation, which includes:

• Education sessions
• Psychiatric/social evaluation
• Transplant financial coordinator evaluation and counseling
• Dietitian counseling
• Chest X-ray
• Carotid ultrasound
• Abdominal ultrasound
• Triphasic spiral CT/MRI
• EGD/Colonoscopy
• EKG
• Echocardiogram
• Pulmonary functions with ABGs
• Adenosine myoview or cardiac catheterization

The following tests are the responsibility of the patient:

• Mammogram within 12 months for females over 40
• Pap smear within 12 months for females over 18
• PSA within 12 months for males over 50
• Colonoscopy for patients over 50
• Dental evaluation within 12 months

Call 704-355-6924 for information regarding the referral process. It is important that the transplant team know as much as possible about each potential candidate for transplantation. For questions or transfers, you may contact the liver transplant coordinator at 704-355-6649 or 800-562-5752.

Once a referral is made, patients are evaluated by the Liver Transplant Program.

The following issues must be addressed before progressing to transplantation:

• Patient's fitness for surgery
• Psychosocial preparedness
• Potential for recovery
• Adequate social support structure
• Any pre-existing medical conditions unrelated to the liver disease that would make transplantation unnecessarily risky

Common contraindications to liver transplantation:

• Ongoing substance abuse
• Noncompliance

Wait List Maintenance

Liver transplantation is a complicated decision for both physicians and patients. In each case, a terminal illness is being replaced by a new and chronic condition. The transplant team must ensure that patients are neither too ill nor too healthy to warrant a transplant. The patient must have sufficient medical reserve to survive through and thrive after transplantation. Risks are involved not only for the patients undergoing transplantation but also for those remaining on the waiting list. These principles guide our transplant team as decisions are made affecting each patient we care for.

How Organs are Allocated

Organ allocation guidelines are based on United Network for Organ Sharing and Organ Procurement Transplant Network policies that include medical criteria, as well as equitable utilization of organs. The current liver allocation policy is based upon MELD score and blood type. Patients within a blood group with the highest MELD score receive highest priority. Other factors include age and body size of donor and candidate.

For questions about the Liver Transplant Program or Carolinas Center for Liver Diseases at Atrium Health, call 704-355-6649 or 800-562-5752.