Getting Placed on the Liver Transplant Wait List
Once patients are approved by the liver transplant team, cleared by the financial coordinator and their insurance company, they are placed on the United Network for Organ Sharing (UNOS) waiting list. UNOS is the agency authorized by the federal government to maintain the database for all transplant recipients in the United States
Being placed on a waiting list means that a patient’s name and certain medical information is entered into a national database maintained by UNOS. Since the list is based on medical urgency as determined by MELD (Model for End Stage Liver Disease) score, a patient’s position on the list may fluctuate based on their health status and as other patients are listed and transplanted.
The MELD Score is based on four lab values, including creatinine (kidney function), bilirubin (liver function), sodium (electrolyte that can be altered with liver disease) and INR (clotting factor). This score is updated periodically while awaiting transplant; how often depends on how sick you are and MELD ranges from 6 to 40.
According to the Organ Procurement and Transplantation Network (OPTN) Policy, Table 9-1:
| If the candidate is: |
The new laboratory values must be reported every: |
And when reported, the new laboratory values must be no older than: |
| Status 1A or 1B |
7 days |
2 days |
| MELD 25 or greater (ages 18 and older) |
7 days |
2 days |
| MELD or PELD 25 or greater (less than 18 years old) |
&14 days |
3 days |
| MELD or PELD 19 to 24 |
30 days |
7 days |
| MELD or PELD 11 to 18 |
90 days |
14 days |
| MELD or PELD 10 or less |
365 days |
30 days |
Donor livers are allocated by UNOS and the regional organ procurement organization, Gift of Life Donor Program. Each donor is evaluated carefully by the Gift of Life and Penn Transplant Institute surgeons. Livers are allocated based on MELD score, blood type, age (pediatric vs adult) and transplant center’s distance from donor hospital. Time on the waitlist is a tie-breaker. Other factors that may impact liver allocation is size of donor and recipient and travel time to the hospital.
Things To Do While Waiting for a Liver Transplant
There are many things patients can and should do while waiting for a liver transplant, including:
- Continue to exercise regularly to promote endurance and speed up recovery after transplant.
- Follow dietary guidelines.
- Take all medications as prescribed.
- Keep up to date on basic tests and appointments while awaiting transplant.
- Carry a cell phone when not at home. The Penn transplant team needs to be able to contact patients on the waiting list at any time.
- Pack bags and make arrangements for transportation to the hospital in advance.
- Become familiar with post-transplant care.
- Set up a support group of family and friends to help after your surgery.
Notify the transplant program:
- About any other surgery or hospitalizations
- Any change or lapse in medical insurance
- Any address or phone number changes
- Any additional emergency contacts we can call at time of organ offer
What Happens When a Donor Liver Becomes Available?
When a suitable donor liver becomes available, the on-call coordinator calls the patient to discuss the donor as well as any potential risks. If you have questions about accepting the liver, please ask to speak with your transplant hepatologist.
Our on-call team will provide further instructions at the time of the call, including when and where to report to the hospital and when you should stop eating and drinking.
Upon arrival, you'll be admitted to the hospital room, and the transplant team will begin preparing for surgery. They complete paperwork, review medications, check vital signs and draw blood. Patients wait in their hospital room with their support team until it is time to go to the operating room for their liver transplant surgery.
If families need somewhere to stay during the length of the hospitalization, please call the Clyde F. Barker Penn Transplant House as soon as you know you will need a room at 215-662-4540.
Too Sick for Transplant
Patients who are considered to be temporarily unsuitable for liver transplant are listed as inactive (Status 7). Reasons include being too sick for transplant, lack of insurance, patient choice, and medical, surgical or psychosocial contraindications.