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< Liver Program Overview

Your Liver Treatment Plan

Start Your Journey

Start Your Liver Transplant Application

Your application to our liver transplant program is more than paperwork. It's your story, our transplant team's window into your medical history and the first step toward finding your liver match. From your first name to your last lab report, every little piece of information you share helps paint a bigger picture that arms us with the knowledge we need to start you on the right path to the right liver. That's why it's so important to cross every "t," dot every "i" and read every word.

Collect Your Medical Records

Just as important as what's written on your application is the following list of medical records. Together with your application, these records help illustrate your journey up until this point. They're essential to helping us move the transplant process forward and we can't accept your application without them.

Send the following medical records along with your completed application form:

  • History and physical (typed copy from hepatologist or gastroenterologist)
  • Current office notes/progress notes from hepatologist or gastroenterologist)
  • Recent labs from hepatologist or gastroenterologist
  • Copies of insurance cards and drug coverage cards: front and back
  • Completed Insurance Information sheet (page 4 on the application)
  • Pathology reports for any patient with a history of cancer
  • Pathology reports for any liver biopsy
  • Results of viral loads of Hepatitis B and or Hepatitis C

All diabetic patients and all patients older than 50 need to provide the following documents:

  • Nuclear Stress Test results within the last 12 months
  • Written cardiac clearance for transplant surgery

You'll need to schedule the following tests with your private physicians, but reports aren't required to begin processing your application:

  • Colonoscopy is required every 5 years (patients older than 50; send report if available)
  • Pap smear and mammogram need to be done annually (females only; send report if available)

Send In Your Application

Mail or fax your completed application and medical records to:
Florida Hospital Transplant Institute
2415 N. Orange Ave, Suite 700
Orlando, FL 32804
Fax: 407.303.2998

We know waiting isn't easy. But we hope it helps to know that once we receive your application and medical records, your information is in good hands and your well-being is on our minds. Your transplant nurse coordinator will carefully review your application and medical records to ensure you meet the liver transplant requirements. Once it's approved, we'll forward your records to a financial coordinator for review and approval of insurance and medication coverage. The second we get the green light, we'll be in touch to help you take the next step: Evaluation.

Read About Evaluation
Evaluation

Patient Evaluation: Our Personalized Approach

Our personalized liver transplant evaluation process is designed to ensure you have a successful liver transplant and the resources you need to care for it. Over the course of several weeks, you and your caregiver will get to know your transplant care team while undergoing a series of medical tests. It's an integrated process that's as much about assessing your physical health as it is your emotional health. Just as important, it's an opportunity for you to share your questions and concerns, introduce us to your caregiver, and talk about what to expect before, during and after your liver transplant.

Walking Through Your Medical History

Your transplant hepatologist will be the first to review your file and assess whether you meet our team's liver transplant patient requirements. Liver transplants are reserved for critically ill patients, mainly those with end-stage irreversible liver failure and, in some cases, patients with liver cancer. There are numerous reasons you may be experiencing liver failure, including:

  • End stages of cirrhosis
  • Liver cells replaced by scar tissue, causing a loss of liver function (often caused by alcoholism and hepatitis B and C)
  • Fulminant hepatic failure
  • Acute liver failure without any history of liver disease
  • Selected patients with primary liver cancer (hepatocellular carcinoma)
  • End stages of hemochromatosis
  • Excess iron accumulation in the body
  • Alpha-1 anti-trypsin deficiency affecting the liver
  • Incorrect production of A1AT
  • Metabolic disorders
  • Any metabolic disorder that leads to liver disease and additional complications

Our team of hepatology experts will get to the root of your liver failure and make sure there's no other course of treatment to explore before recommending a liver transplant.

Lab and Diagnostic Testing

To make sure your body is ready to undergo a successful liver transplant procedure, we perform our own series of lab and diagnostic testing on every single patient. Our team will guide patients and caregivers through the following tests in the comfort of our state-of-the-art Orlando facility:

  • Complete blood workup
  • Ultrasound exam of liver and other abdominal organs and blood vessels
  • CT or MRI of Abdomen
  • Cardiac stress test
  • Echocardiogram (a heart exam done by ultrasound)
  • Electrocardiogram (measures your heart's electrical activity)
  • Endoscopy (a small tube with a tiny video camera examines internal organs)
  • Mammogram and various X-Rays

Your transplant hepatologist will walk you through your test results and any additional testing needs.

Meeting Your Transplant Team

Our patients and their caregivers often say their transplant team becomes like a second family. So it's only natural that the first step is getting to know each specialist on your transplant team. And even though these are one-on-one meetings, your dedicated health team stays closely connected throughout your evaluation process through close communication and innovative technology.

Your Social Worker is here from day one to support your journey and make sure you're mentally and emotionally ready to undergo a liver transplant. Their line of questioning will make sure you and your caregivers are ready to take care of your transplant by following the medical team's recommendations to the T. If they feel you need additional resources, whether it's housing or financial assistance, they'll help connect you to the right resources in your community.

Your Dietitian is focused on keeping you as healthy as possible before, during and after surgery. Nutrition plays a critical role before, during and after surgery, so it's essential that you follow your dietitian’s meal plan morning, noon and night. They'll help you stay mindful about what you put into your body leading up to liver transplant surgery and help you understand how certain medications may affect your appetite and/or interact with certain foods and substances. After surgery, your dietitian will create a detailed eating guide designed to keep your new transplant working like new.

Your Transplant Hepatologist will review your test results and your medical history in detail, addressing any unanswered questions or concerns. If more tests are necessary, they'll guide you through what needs to happen next. Your transplant hepatologist will also take care of your medical needs as you recover from surgery.

Your Transplant Surgeon and Nurse Practitioner are a team working toward your successful liver transplant and long-term health. During this hour, they'll walk you through what to expect before, during and after surgery.

These are meant to be candid conversations with a group of people who are as invested in your health as you are. Bring the questions that keep you up at night. Bring your support person. And bring your fighting spirit.

Patient Review Committee

Once you've met with every person on your transplant team and your test results have been processed, your transplant coordinator will present your case to the Patient Review Committee. Together, they'll review your case to determine your best course of treatment. If your team is confident a transplant is the best option for you, your name will be placed on the national organ waiting list.

Multiple Listings

You're taking charge of your health, and that means you have every right to be evaluated by different transplant centers. Just let us know if you've already been evaluated by another center so we can avoid duplicate testing and move your evaluation along faster. Our team can help obtain these records. Remember that each center evaluates and accepts patients based on their own criteria, and being listed at one center doesn't guarantee that every center will accept you.

What If I'm Not a Candidate for a Liver Transplant?

Our commitment to comprehensive hepatology care means we specialize in whole-patient care that goes beyond transplants. Once you're referred to our liver transplant program, our world-renowned hepatology specialists work tirelessly to determine which treatment will works for you, even if a liver transplant isn't an option.

Explore Our Advanced Hepatology Program

Read About Waiting List
Waiting List

We'll carry the weight of waiting with you.

We know the question that keeps you up at night: "How long will I wait?" We can't answer that question with certainty. But we can tell you that our median wait time is 47.9 days, less than one-quarter of the national average. Your transplant coordinator will keep you informed from the moment your name is put on the list, to the second we find the right liver for you. And during the moments in-between, when you're waiting for the phone to ring, we're here to answer your questions and support you with a listening ear.

How the Liver Transplant Waiting List Works

The United Network for Organ Sharing (UNOS) manages the list of everyone across the country waiting for an organ transplant. If you meet the transplant criteria, your transplant care coordinator will add you to the liver transplant list. Your information — including your blood type, medical urgency and our institute's location — is entered into the UNOS computerized network. Your place on the list depends on your MELD score (Model for End-Stage Liver). The more urgent your needs, the higher you'll be on the list. Your MELD score will be reevaluated periodically to keep the waiting list as accurate as possible. When an organ procurement organization confirms that a deceased donor liver is available, the donor's information is entered into the same system. Using the combination of your information and the donor's, the UNOS computer system generates a "match run," a "rank-order list" of candidates.

Liver Transplant Pre-Education Class

We've seen first-hand that patient education is key to a successful liver transplant. The more you and your support system know about how to care for yourself before, during and after your transplant, the more likely you are to follow your team’s medical recommendations throughout the process. That's why once your name is added to the national organ waiting list, we'll invite you, your family and/or your caregiver to attend a mandatory educational session at our Orlando facility. During this three-hour session, our transplant education team will guide you through each step of the liver transplant process in detail, from how the waiting list works to what resources are available to you after surgery and recovery. This session also serves as an open forum, and we encourage you, your caregivers and members of your support system to ask any questions you may have.

What Can You Do While You Wait?

Resolve to focus on the things you can control: your day-to-day health and habits. And during the moments in-between, when you're waiting for the phone to ring, we're here to answer your questions and support you with a listening ear. Choose salad over sweets. Get in steps wherever you can. Keep up with your routine health screenings, from dental visits to eye exams. And whenever you need to, take a break. Focusing on your whole health is the best way to make sure that when the right liver becomes available, your mind and body are ready to receive it well.

Be sure to let us know if you have any address, name or insurance changes and let your transplant coordinator know of any illness, surgery or hospitalization. You can also put a plan in place for when you do receive the call. More than likely, you’ll need to get to the Florida Hospital Transplant Institute in Orlando immediately. Have a designated driver, established transportation in place, and a travel bag packed at all times.

Getting the Call

Your transplant care coordinator will be the first to call you the moment we think we have the right liver for you. Most patients say it's a moment they'll never forget. Let it sink in. Then make arrangements to come to our Transplant Institute immediately for final evaluation and pre-op. Don't eat, drink or take any medication after you receive the call.

Read About Surgery
Surgery

What to Expect With Liver Transplant Surgery

Once you receive the call and you arrive for your liver transplant surgery, we'll be ready. Your transplant care team will walk you through the entire procedure from start to finish and answer any questions you may have.

Helping You Understand the Risks

As with any surgery, there are risks. We're here to help you understand the potential complications. Some specific liver transplantation risks may include:

  • Organ failure. Your new liver may fail to function properly.
  • Bile duct complications (leakage, shrinkage or blockage)
  • Hepatic artery thrombosis (blockage of artery going to liver)
  • Recurrence of Hepatitis C
  • Tissue rejection. Our bodies are smart, and when you receive your new liver, your immune system will sense the new tissue. We'll give you immunosuppressive medications to help your body accept its new liver.
  • Immunosuppressive medications side-effects. These side effects may include upset stomach, facial hair, acne, or gain weight. These meds may also increase your chances of developing some types of cancer. Other immunosuppressant side-effects may include bone thinning, diabetes, skin sensitivity, puffiness, swollen gums, high blood pressure and increased cholesterol.

We've made incredible strides over the last few decades, and while the possibility of risks will always exist, liver transplantation has never been a safer, more effective long-term solution. After we've answered all your questions, we'll ask you to sign a consent form, giving us your permission to perform your liver transplant.

Before Surgery

Depending on your medical condition at the time, your transplant team may take additional steps to get you ready for surgery. Your transplant nurse will set you up with an IV line to administer medications as needed. You'll also receive your first dose of anti-rejection drugs and antibiotics, which help your body get ready to accept its new liver. And if you need a hand to hold, we can do that too.

During Surgery

While you're getting your healthy new liver, you'll be surrounded by a team of world-renowned liver transplant surgeons and specialists that has collectively performed more than 600 liver transplants. They'll monitor every detail, from your heart rate and blood pressure to your blood oxygen level. To help you breathe, your transplant team will insert a breathing tube into your windpipe. The details of your surgery may vary depending on your specific condition, but most liver transplants take approximately two to four hours and are done under general anesthesia.

After Surgery

This is where the road to recovery and a healthy new life begins. No patient's plan is the same, and how long you stay in the hospital depends on a variety of factors, but most patients stay anywhere between one and three weeks after a liver transplant. You'll likely spend the first 24-48 hours in the intensive care unit before you're transferred to the transplant unit for the rest of your hospital stay. More than likely, your team will recommend that you and your caregivers keep visitors to a minimum in order to reduce the risk of infection.

You'll start feeling like yourself sooner than you think. Your appetite will come back. Energy levels will rise. We'll monitor you closely through daily exams, regular blood work and various radiologic tests to make sure your liver is working as expected and that no infections are present. Your nurse will guide you through exercises and therapies designed to keep your lungs clear and get you back on your feet.

Read About Staying Healthy
Staying Healthy

Life After a Liver Transplant

The road to a liver transplant is long, but our journey doesn't end with surgery. We'll guide your recovery every step of the way, empowering you with the information, tools and resources you need to care for your new liver throughout your life's journey.

Outpatient Institute Visits

Once you're cleared to leave the hospital, your team will continue to help ease your transition to independent living. You'll leave Florida Hospital armed with detailed instructions, a supply of meds and a list of phone numbers to contact for any questions or emergencies.

We'll be in close, regular contact with you through your nurse coordinator. And since we'll need to see you in our Institute three times a week for three months, our team can help arrange local housing, whether at the Bartch Transplant House (if you meet the requirements) or elsewhere.

Between lab work and one-on-one check-ins with your transplant team, you can expect each visit to last about four hours. After one month, we'll reduce your visits to two times per week, and eventually, to once a week. At the end of the three-month period, we'll refer you back to your hepatologist for routine care, and we'll see you back at our Transplant Institute every year for your annual visit.

A Healthy Lifestyle

Treating your new liver with care means treating your body well. Eat smart. Exercise with heart. And never forget the physical, emotional and mental challenges your mind and body have overcome. Your transplant team will create a detailed health and maintenance plan, from diet and exercise recommendations, to how to avoid infection.

Medications

Anti-rejection medications help prevent liver transplant rejection and will be part of your daily routine from this day forward. Without them, your body may begin to reject your new liver. Your transplant team will give you detailed instructions on how and when to take your medications.

Ongoing Education

Throughout the year, our transplant education team hosts individual sessions on a variety of specific topics such as nutrition, keeping your new organ functioning properly, caregiving, etc. All patients and members of their support system are welcome to attend these sessions as part of their organ transplantation journey.

Transplant Support Groups

Sharing your experience with other liver and organ transplantation patients can be an essential part of the recovery and maintenance process for many patients. We’ll connect you to local and national resources online and in your community.

Staying Connected

We're part of your story and you're part of ours. In addition to your annual physician visits to our Institute, we keep our team-patient connections going strong through annual events like our annual Patient and Family Picnic and the GR8 to DON8 race.