Donor Livers
Most liver Transplant patients still receive their donor livers from a cadaver donor (someone who is declared legally dead). People who have signed Donor cards, and who have informed their family before death that they wish to be an organ donor, share the gift of life by helping others through this selfless act.

According to records from the Scientific Registry of Transplant Recipients, there were over 17,000 people awaiting liver transplants in 2002 ( www.ustransplant.org). People in need of a liver transplant are placed on a waiting list with other liver patients that is kept by  UNOS, the  United Network for Organ Sharing. This national organization is charged with fairly setting a priority for organs as they become available across the country. Priority is based on  MELD score. The MELD system assures that donated livers go to the patients in greatest need at that moment. In this system, each liver transplant candidate is given a number (“MELD score”), which is determined from three routine laboratory tests (measuring bilirubin, creatinine, and prothrombin time) and whether there is a tumor in the liver. Since the MELD score must be updated periodically, it may decrease or increase depending on the severity of the patient conditions. Patients with a higher MELD score will always be considered for a liver transplant before those with lower scores.

Cadaver livers are recovered from people who have died suddenly, usually from an accident or bleed into the brain, and have previously expressed to their families a willingness to donate their organs. These donors are tested extensively to insure that they do not pose a health threat to the recipient. A cadaver transplant can be received from a person of either sex or any race without the recipient being affected in any way. As soon as the cadaver donor is declared legally brain-dead, the liver is removed and placed in sterile fluid similar to the fluid in body cells. They are then stored in the refrigerator. We normally try to transplant all livers within 12 hours of recovery. This is the reason that many patients are called to come to the hospital in the middle of the night. In fact, the sooner the liver gets transplanted after its recovery, the better the results and quality of life for the recipient.

Donor Matching
Liver donors are usually between the ages of 1 and 70 years. They have been relatively healthy before their death. Many studies are performed to insure that their organs function perfectly. Their families have made the decision to donate their organs so that someone else will have a chance to live a better life.

It is unnecessary to match the donor and the recipient for age or sex. Only the body size and blood type must be matched. All donors are screened for hepatitis viruses and the AIDS virus.

When A Liver Has Been Found
When a liver has been located and a match made with a recipient, the patient is called. Normally, patients are asked to come directly to Jefferson’s Emergency Department. There, patients are examined before receiving the final okay to proceed with the surgery.

Before Surgery Begins
Patients are required to fast prior to surgery. “Fasting” means not eating or drinking before surgery is set to begin.

To prevent post-surgery constipation, an enema may be given to clean out the intestines.

The chest and abdomen may be shaved to prevent infection.

Anesthesia
On the day of surgery, a Transplant Anesthesiologist inserts an intravenous (IV) into the patient’s arm. This will allow for the administration of medications. The patient is given a sedative to relax. Other medications are given throughout the procedure. Doctors will explain more about these drugs prior to surgery when consent is obtained.

Prior to the surgery, the patient is “intubated.” This is when a breathing tube is inserted that helps the patient breath during the procedure.

For liver transplant surgery, patients are given general anesthesia. They are completely unconscious and do not feel pain.