Last updated: 02/17/2009

The liver starts to fail only when more than half of it is damaged. Thus, once a person demonstrates symptoms of liver failure, there is not much liver function left. Signs and symptoms of liver failure include:

• jaundice
• muscle wasting...
  
  (loss of muscle)
• forgetfulness, confusion, or coma
• fatigue
• itching
• poor blood clotting
• build-up of fluid in the stomach (ascites)
• infections
• bleeding in the stomach

A doctor will diagnose liver disease; a liver specialist, a transplant surgeon, and other doctors will have to be consulted, as well, before a patient can be considered for a liver transplant. Before transplantation takes place, the patient is first determined to be a good candidate for transplantation by going through a rigorous medical examination. Blood tests, consultations, and x rays will be needed to determine if the patient is a good candidate. Other tests that may be conducted are: computed tomography (CAT or CT) scan, magnetic resonance image (MRI), ultrasound, routine chest x ray, endoscopy, sclerotherapy and rubber-band ligation, transjugular intrahepatic portosystemic shunt (TIPS), creatinine clearance, cardiac testing (echocardiogram [ECHO]) and/or electrocardiogram [EKG or ECG]), and pulmonary function test [PFTs]), liver biopsy, and nutritional evaluation. A dietitian will evaluate the patient's nutritional needs and design an eating plan. Since a patient's emotional state is as important as their physical state, a psychosocial evaluation will be administered.

Once test results are reviewed and given to the liver transplant selection committee, the patient will be assessed for whether he or she is an appropriate candidate. Some patients are deemed too healthy for a transplant and will be followed and retested at a later date if their liver gets worse. Other patients are determined to be too sick to survive a transplant. The committee will not approve a transplant for these patients. Once a patient is approved, they will be placed on a waiting list for a donor liver. When placed on the waiting list, a patient will be given a score based on the results of the blood tests. The higher a patient's score, the sicker the patient is. This results in the patient earning a higher place on the waiting list.

Suitable candidates boost their nutritional intakes to ensure that they are as healthy as possible before surgery. Drugs are administered that will decrease organ rejection after surgery. The medical committee consults with the patient and family, if available, to explain the surgery and any potential complications. Many problems can arise during the waiting period. Medicines should be changed as needed, and blood tests should be done to assure a patient is in the best possible health for the transplant surgery. Psychological counseling during this period is recommended, as well.

When a donor is found, it is important that the transplant team be able to contact the patient. The patient awaiting the organ must not eat or drink anything from the moment the hospital calls. On the other hand, the liver may not be good enough for transplantation. Then, the operation will be cancelled, although this does not happen often.