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Transplant Co-ordinators

 

There are six Transplant Co-ordinators based at St James’s University Hospital.  The majority of our role involves working with families on Intensive Care Units facing end of life care decisions.  We provide information and support to families in this situation to enable them to make informed decisions regarding organ donation.  We work collaboratively with Intensive Care medical and nursing staff to achieve this. 

Other facets of our role include education and working with the media to raise awareness of organ donation.

Additionally we are involved with listing patients and organising liver transplants.  Following liver transplantation, we are available for advice and support for recipients who wish to write to their donor family, click here for further information  

What happens after Transplant assessment?

 

After you have had all your tests and investigations and you have had an opportunity to meet the staff on the Liver Unit and ask all the questions you might have, your case will be discussed by the medical staff and other members of the team.  A decision will be made as to whether a liver transplant is the most appropriate treatment for you. 

They may advise that it might be too early to consider a transplant as you are too well, in which case you will be regularly reviewed by the medical staff to see if your liver disease is deteriorating. 

They may advise you that tests may reveal other problems that mean it would not be beneficial for you to have a transplant.   You and your family will have plenty of opportunities to discuss the test results with the medical staff.

If a liver transplant is not felt to be the most appropriate form of treatment for you, you will be followed up in clinic either at St James’s or at your referring hospital.

They may advise you that you are a suitable candidate for a liver transplant and will ask you whether or not you want to be placed on the liver transplant waiting list.

Listing

If a liver transplant is felt to be the most appropriate form of treatment for you, you will be called back in for an appointment to be placed on the transplant waiting list.  

If it is decided that you should be listed for a transplant, we are required to send your personal and clinical details to UK Transplant (a branch of the NHS dealing solely with organ donation and transplantation) to register you on the National Transplant Database.  This is to ensure that the donor organ you receive is the right match for you.  You can refuse consent for this, however if you are not registered on the National Transplant Database you are likely to wait longer for a transplant and may not be offered the most suitable organ.

Most people are well enough to wait at home for a liver transplant and may only go to hospital occasionally for treatment of symptoms.

Sometimes you can become unwell with infections or have other treatments that would mean it would be unsafe to transplant you at this time, in which case you would be suspended from the waiting list until your condition improves.

Sometimes your condition deteriorates to such an extent that even transplantation would offer you no benefit.  In these circumstances you would be removed from the liver transplant waiting list.  

The Waiting List

 

Depending on your medical condition, you will either wait for your new liver at home or in hospital.  Donor livers are matched to recipients according to blood group, height and weight and the severity of your liver disease.

Unfortunately it is impossible to accurately predict how long you will have to wait.  A liver could become available from the day that you go on the liver transplant waiting list to many months later.

You will be expected to visit clinic once a month or possibly more frequently if your condition dictates while you are waiting for your transplant.  This is important so that the doctors can monitor your condition.  It is important to tell a member of the Liver Unit multidisciplinary Team if you have recently been ill or your condition has worsened since your last visit.

If you become ill or are admitted to hospital whilst on the waiting list, it is important to ensure that the Liver Unit is contacted either by yourself, your family or the hospital ward that you have been admitted to.

Liver Unit contact details 0113 2065771

We would encourage you to have as normal a life as possible whilst on the liver transplant waiting list.  It is your responsibility to inform the Transplant Co-ordinators if you are going away from your home.  It is important to tell the Transplant Co-ordinator

 

 

If you are going abroad you will be suspended from the waiting list whilst you are away as you may not be able to return to the hospital in time for the operation.  It is important that you discuss travelling abroad with your Consultant as you may not be well enough to travel.

Receiving the call

 

It is important to tell the Transplant Co-ordinator if your address or telephone numbers change from the information documented at listing.  You may be given a pager at the time of listing if you do not have a mobile telephone.  This pager is on loan from the Transplant Co-ordinators.  Following transplantation or removal from the list the pager must be returned to the Transplant                Co-ordinators.  When a suitable liver becomes available the Transplant          Co-ordinator will first try to contact you at home then try your mobile or pager.  We will attempt to contact you repeatedly but you must respond swiftly. 

If we cannot contact you we will have to offer the transplant to another patient.

 

The Transplant Co-ordinator will contact you when a liver has potentially become available.  Please remember that despite being admitted to hospital for a transplant, this could be a false alarm as the transplant may have to be cancelled due to unforeseen complications.  Whilst this is disappointing it is important to stress that the transplant has been cancelled as it would have been unsafe to proceed.

Checklist

 

 

 

Contact details

Monday to Friday between 9am to 5pm

0113 2064930 or 0113 2064553. 

Outside these hours contact St James’s University Hospital switchboard on 0113 2433144 and ask them to page the On Call Transplant Co-ordinator.


There is an overall shortage of livers for transplantation; therefore they are indeed a very precious resource.  All livers are considered for transplantation by a consultant transplant surgeon who will only proceed with liver transplantation if he is comfortable with the quality of liver for transplantation and its suitability for the intended recipient.  The consultant will only select a liver for you that is felt to be appropriate for you based on your condition, how long you can safely wait for a liver, your blood group and size.

Types of Liver Donor

 

It is possible to transplant livers from the following types of donor.

Deceased Liver Transplantation

 

Deceased liver transplantation is where a liver is removed from someone who has died as a result of overwhelming and irreversible brain damage called brain stem death.  The liver is removed in the time following declaration of brain stem death and the heart stopping beating.

Asystolic Liver Transplantation

 

This is where a liver is removed from someone after they have died and their heart has stopped beating.  As a result the liver may have suffered some damage from being without blood circulation.  Therefore such livers are only used in certain patients where the risks of the liver not working are deemed appropriate when compared to the risks of the patient not receiving a transplant soon enough.  For this reason asystolic donors are known as marginal donors. 

There are circumstances other than asystolic liver donation where donor livers may be classed as marginal.  This may be because of extremes of age and co-existing medical problems in the donor

Living Donation

 

It is technically possible to remove a portion of a healthy individual’s liver and transplant it into a relative.  Only a small portion of liver is taken from the donor leaving enough to keep the donor healthy.  If your doctors feel this is a potential possibility they will discuss this with you and your relatives and the potential risks involved.

Types of Liver Transplant

Whole Liver Transplant

 

This technique involves removal of the recipient’s entire old diseased liver and a whole healthy liver from a donor is transplanted. 


Split Liver Transplant

 

In this technique the recipient’s whole diseased liver is removed.  The donor liver is split into two, thereby allowing two patients to have a liver transplant from one donor.  In general the smaller left lobe of the liver will be given to a child and the larger right lobe will be given to an adult.  Following transplantation, each liver lobe will grow and form a whole liver.

Auxiliary Liver Transplant

This type of liver transplant is only performed in circumstances where the recipient’s liver may have a chance of recovery on it’s own, if supported. Circumstances include Paracetamol Overdose. This technique involves leaving behind some of the recipients liver at the time of the operation, rather than taking it all out as in whole liver transplantation, at the same time a whole liver is transplanted. With time as the recipients own liver recovers and begins to function, the immunosupression used to keep the transplanted liver working is slowly withdrawn. This technique avoids the necessity of taking life-long tablets. It is only suitable in very few cases, and will be performed at the discretion of the transplant team.

 

Reduced Liver Transplant

Sometimes the new donor liver is too large for the recipient.  The surgeons

reduce the size of the liver by removing some of the donor liver segments.

 

 

 

 

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