The transplant process can leave you with a lot of questions. Whether you are an organ recipient, living donor for liver transplant or trying to figure out insurance policies, we've compiled a list of questions to help you understand the entire process and the finances associated with it. Please contact us if you have any additional questions.

Liver Transplant

Living Donor Liver Transplant 

Insurance/Cost  

Liver Transplant

What is a liver transplant?
One of the most important organs in the body, the liver is essential to good health. When the liver can no longer perform its normal vital functions and there is no other way to correct the problem, a transplant may be recommended. A liver transplant involves surgery to replace the patient's liver with a new liver or part of a new liver, followed by life-long medication and clinic follow-up visits to prevent rejection of the new organ.

What are the different types of liver transplants?

• Deceased donor transplant
  As long as there is a heartbeat, the organs of a healthy person in a traumatic event causing death are good candidates for donation. With consent from the donor's next of kin, artificial support keeps the organs functioning until donation occurs.
• Living donor transplant
  Some patients have loved ones willing to give a portion of their liver, which is possible because livers have the ability to regenerate the donated segment. Living donor transplantation has many advantages, including shorter wait times and the ability to schedule the surgery when the recipient is in good shape. More information

Which patients are eligible for liver transplant?
Patients with acute liver failure may be candidates, as well as those with chronic liver failure due to diseases such as hepatitis B & C, metabolic diseases, some liver cancers and biliary cirrhosis. There are other conditions that result in the need for transplantation, but regardless of the cause, the need for transplantation is determined by the occurrence of liver failure.

Which patients are NOT eligible for liver transplant?
Patients with the following conditions may not be eligible for liver transplant:

• Liver cancer that is too extensive or has spread from the liver to other parts of the body
• Some types of cancer other than liver
• Recent heart attack, angina at rest or advanced heart disease
• Untreated or uncontrolled major psychiatric illness
• Non-rehabilitated substance abuse
• Major infections such as AIDS or current TB
• Current pregnancy
• Age of 70 or greater

How are potential transplant patients evaluated?
With a referral from their primary physician, potential candidates are given a pre-transplant evaluation. This includes:

• personal interview with the patient
• visits with a social worker and financial counselor
• complete medical work up including lab tests, abdominal ultrasound and/or CT scan, psychological clearance, colonoscopy, EKG and a number of other tests

The transplant team will review the evaluation results, and if they find that the patient would be a good candidate for a liver transplant, and financial arrangements are in order, the patient is officially listed on the recipient waiting list with the United Network for Organ Sharing (UNOS).

The evaluation can take four to six hours or longer. Some patients may prefer to spend the night near the hospital if they live out of town. An excellent option for an overnight stay in a compassionate environment is Nora's Home, which offers a home away from home at a nominal fee for transplant patients and their families. Call 1-877-390-4663 for reservations.

The evaluation process also involves scheduling of tests and other physician referrals, so it may take several weeks to complete the evaluation and place a patient on the transplant waiting list.

What happens after a patient is placed on the waiting list?
Patients listed for a liver transplant are tested at intervals and assigned a Model for End-Stage Liver Disease score, which is based on a system regulated by UNOS. The MELD score uses several measures to provide an indicator of a liver patient's health. Patients with higher scores are given priority for transplants. Patients who have sudden onset, rapidly worsening liver disease and are currently in intensive care with a life expectancy of less than seven days are given priority, as well.

Generally, transplant outcomes improve when patients are in the best possible shape. We encourage patients to use the waiting period as a time to lose weight, if necessary, to enrich personal relationships, to find and use ways to reduce stress and to improve diet and exercise habits. For patients who are currently smokers, they should quit as soon as possible.

Keeping in Touch
If a patient is listed on the recipient waiting list, the transplant team needs to be able to reach them quickly. If there is any change of telephone number, address, insurance or medical condition, the transplant coordinator must be informed right away.

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Living Donor Liver Transplants

Who will benefit from living donor liver transplantation?
Over 12,000 patients are currently awaiting liver transplantation. Of these, approximately 10% will die while waiting for a cadaveric organ. Obviously, all patients who have fulfilled the selection criteria for liver transplantation will benefit from the procedure at an earlier stage in their disease. Those patients with hepatocellular carcinoma, sclerosing cholangitis or fulminant hepatic failure may derive additional benefits from early transplantation.

Is living donor liver transplantation better then receiving an organ from a recently deceased donor?
Although not enough adult living donor liver transplants have been performed to answer this question, it is believed that the living donor organ may be a better option for some patients for the following reasons.

• Patients receive their transplant on an elective basis when they are not hospitalized for hepatic decompensation. The elective nature of these procedures should lead to a reduction in morbidity and mortality.
• The cold ischemic time (time between taking the organ out and placing it into a recipient) is minimal.
• The liver is procured from a young healthy hemodynamically stable donor. The reduced cold ischemic time and the quality of the donor organ contribute to the success of the transplantation.
• A living organ donated from a family member theoretically provides an immunological advantage.

Am I a candidate for living donor liver transplantation?
Not all patients awaiting liver transplantation will be candidates for living donor liver transplantation. Below are some guidelines. These criteria are not absolute and each patient will be evaluated on an individual basis.

Recipient Inclusion Criteria

• Patients with stable end-stage liver disease eligible for transplantation by standard criteria for cadaveric donors. This includes all patients with a Child's-Pugh score of greater than 7. Patients with a Child's-Pugh score of less than 7 may be candidates if there is another reason for liver transplantation such as hepatocellular carcinoma.
• Age 18-60
• Recipient dry weight of less than 200 pounds
  * Negative T-cell crossmatch with the donor

Recipient Exclusion Criteria

• Recipients with a positive T-cell cross-match with the donor
• Pregnant or nursing females
• Patients with significant infections
• Significant pulmonary disease
• Re-transplants

Who can be a donor for a living liver transplant?
The donor has to be a family member or emotionally related friend of the family. Only healthy adults will be considered. The selection criteria are very strict and the potential donors will undergo an extensive series of tests to determine suitability for the procedure.

Donor Inclusion Criteria

• Age 18-55
• No current or prior history of heart, lung, or other medical problems
• No history of liver disease
• No history of malignancy
• ABO compatibility with the recipient
• If female and pre-menopausal, a negative pregnancy test
• Stable relationship with recipient

What are the risks of the procedure?
The most serious risk to the donor is death. The risk of death has been estimated from numerous studies involving over 2,000 living donor liver transplants in children and from studies on liver resection in adults. It is estimated that the risk of dying is 1 in 1,000. Other complications such as bile leaks or postoperative infections are usually minor and can be treated without further surgery. These complications occur in approximately 10-15% of donors.

The risks to the recipient are centered mainly around the adequacy of the liver tissue transplanted. Studies have shown that for a successful transplant, the recipient needs to receive at least 30% of their estimated liver volume. The Transplant Institute attempts to transplant at least 40% of the estimated liver volume of any given recipient.

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Insurance/Cost

What part of the transplant cost is covered by my insurance? How does this apply to my deductible?
Coverage varies depending on the patient and the company. Most commercial plans cover solid organ transplants to a certain degree. To find out what your company covers, contact them directly. Our financial coordinators are available to help you find the information you need.

What is the cap on my commercial insurance coverage? What happens if my financial coverage runs out?
Because most commercial plans have a lifetime maximum $1,000,000 and up, it is unusual to exceed that amount. If it happens, there are other options available. Our financial coordinators will help you find the one for you.

Are expenses for food, housing and transportation covered while I wait for my transplant?
These costs are rarely covered. Plan ahead for costs associated with these services. Again, our financial coordinators are available to help you find possible assistance.

How much coverage will I receive for post-transplant medications? What is the co-pay amount?
This depends upon your insurance coverage. Most plans have predetermined benefits for the pharmacy network it covers. Ask our financial coordinators for help understanding coverage needs.

What financial coverage is accepted by the hospital (such as Medicare, Medicaid, private insurance)?
Although your insurance company allows you to come to our facility for certain hospital services, you might not be covered for transplantation here. Often, the referring physician determines the location. Our financial coordinators will verify the location to make sure patients don't incur unnecessary financial burdens.

How much will the transplant cost? How much will I have to pay?
Although transplants are expensive, don't get discouraged. Your insurance company will pay a large part of your transplant costs. Your out-of-pocket costs depend upon your coverage (there is usually a maximum annual out-of-pocket cost). Our financial coordinators are here to help you put it into perspective, and payment plans are available to help pay remaining costs.

Other transplant-related expenses to consider:

• Loss of income due to leave of absence from work
• Child care (if appropriate)
• Transportation to and from the hospital
• Parking expenses for visits to the Transplant Institute (if applicable
• Accommodation expenses or temporary housing expenses associated with being accessible to the Transplant Institute (for you and family members)
• Long-distance telephone expenses if relocation is necessary (to be more accessible to the Transplant Institute)
• Food expenses for family support person
• Post-transplant medication costs
• Post-transplant follow-up tests and appointments

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