Liver Transplantation

If you would like additional information about liver transplantation, please ask your doctor to contact the Liver Transplant Program at Ohio State at 614-293-4100.

After your doctor has made a referral for you, you will be contacted by our office for an appointment to see a member of our transplant hepatology team. After that initial visit, the decision may be made to refer you for evaluation for our liver transplant list.

Our team here at Ohio State will then help you with verification of insurance benefits. Liver transplant is not always covered by insurance. Once your insurance company has given the approval for a liver transplant evaluation, we then schedule the necessary testing.

Testing is performed to help our doctors determine if liver transplant is needed and if it’s the best choice of treatment. Our goal is to schedule the majority of the pre-transplant testing during a one-day visit. This testing may include lab work, imaging and heart and lung testing. It is strongly preferred that these tests be completed at Ohio State’s Wexner Medical Center.

You will be asked to have a dental evaluation. Females will be required to have a mammogram and Pap smear if they have not been done within the past year.

After testing is completed, you will take part in an evaluation and education program at our Comprehensive Transplant Center. You will meet the pre-transplant coordinator, surgeon and social worker. We will answer your questions about liver transplant surgery.

During this evaluation, we will detail the surgery, medications, recovery and rehabilitation associated with the transplant process. The main focus is on educating you and your family.

Every patient will receive a physical examination. You will be asked detailed questions about your medical history, prior surgeries and medications. It is best to attend with a thorough list.

Every patient being evaluated for liver transplantation will have a psychosocial assessment with a social worker to determine if you have the psychological stability, motivation and personal support to meet the challenges of transplantation. Before the appointment, you will complete a psychosocial survey that will be reviewed during the evaluation. You may be referred to see a transplant psychologist for further assessment.

If it is determined that you are an appropriate candidate for liver transplantation, you will be listed for a liver transplant with United Network for Organ Sharing (UNOS).

A letter is sent to your insurance company providing recommendations for transplantation and requesting approval for transplant surgery, medications and follow-up care. Once approval is given, you are then listed for liver transplantation on the UNOS national waiting list. A letter will be sent to you detailing your responsibilities while waiting for your transplant.

If deferred or denied listing for a liver transplant at our facility, a letter will be mailed to your home specifying the reasons why you were not listed for transplant. However, this may include criteria requirements that need to be completed prior to listing.

Please be prepared to wait as long as several months for your liver transplant. The donor must have a blood type compatible with yours and be similar in body weight and size to you. Each potential donor also must be screened very carefully for disease, infection or trauma to ensure that you receive a healthy liver.

The process for prioritizing candidates waiting for liver transplant is based on each person’s Model for End-stage Liver Disease (MELD) and sodium (Na) score. The MELD-Na score assigns a numeric score ranging from six (6), which means the liver is working well, to forty (40), which means the liver is working poorly and the person needs an urgent transplant. The number is calculated by a formula using four routine lab test results:

• Bilirubin – measures how effective the liver excretes bile
• INR/prothrombin time – measures the liver’s ability to make blood-clotting factors
• Creatinine – measures kidney function
• Sodium – measures the body's fluid balance

If you want to enter your lab values to know your MELD-Na score, you can use this MELD-Na calculator.

While you are waiting for your transplant, your lab work will be done and MELD-Na score calculated weekly to monthly as determined by UNOS requirements. The length of time waiting for a liver transplant depends on your medical condition as evidenced by your MELD-Na score and other factors including your blood type, donor availability and your size.

You will be followed by our hepatology team here, and will also continue to be followed by your primary care physician and other specialists until transplantation takes place.

You must be reachable by phone at all times. When a liver becomes available for you, you will be notified by the pre-transplant coordinator and admitted to the transplant unit on the ninth floor of Rhodes Hall.

You will have multiple lab tests done to ensure you are ready for transplant. You will be given a number of medications, including antibiotics, antifungals and immunosuppression medications.

Ideally, surgery is performed as soon as the organ is available. However, using the latest perfusion techniques, we are able to transplant livers within 12 to 24 hours after organ recovery. The surgery will generally last from four to six hours or longer.

After your surgery, you will be transferred to the surgical intensive care unit for at least 24 hours, then transferred to the transplant unit as soon as possible. Your hospital stay could be 10 days to two weeks, depending on complications and your condition.

You will be seen daily by the transplant surgeons, advanced practice providers and discharge coordinators. You’ll receive individualized education from floor nurses and attend education classes on medication and general discharge instructions. The discharge coordinators manage your care process, communicate with insurance case managers and plan for discharge. A social worker will visit you to address any psychosocial issues associated with the transplant.

A post-transplant coordinator also will call shortly after discharge to answer any remaining questions and to discuss long-term follow-up with the transplant program.

Once you are discharged, you are followed on an outpatient basis with vital signs and laboratory profiles evaluated by a transplant coordinator and a transplant surgeon. Within one week of discharge from the hospital, you will be seen in the outpatient clinic and then adhere to a closely monitored outpatient schedule particularly during the first year post-transplant.

You will be seen annually thereafter, unless more frequent visits are required. After you are released by your surgeon, you will be seen by the Transplant Medicine Service. Lab frequency is reduced as you progress.

We will communicate with your referring physician at the beginning and end of each hospitalization, as well as with each outpatient clinic visit.

Because of the many interactions of other medications with immunosuppressives, please check with the post-transplant office prior to filling any prescription.

This doctor, who specializes in liver transplants, will follow you before, during and after your transplant. They will complete a physical exam and discuss what additional testing is needed in order to prepare you for your transplant. They may perform your liver biopsies after your transplant.

This doctor will perform your liver transplant surgery. They will discuss the risks and benefits related to the surgery and assist you in understanding what to expect after receiving the transplant.

These doctors, who specialize in infectious diseases, will follow you before and after your transplant (if needed) to reduce risk of infection.

The advanced practice providers include physician assistants and nurse practitioners who work closely with your physician to ensure continuity of care throughout your stay at the hospital and your transition to outpatient care. He or she orders and monitors diagnostic tests and treatments, responds to urgent needs, diagnoses and treats problems if they arise and provides the educational tools and resources necessary to continue success with your transplant once you are discharged.

These are nurses who will be your primary contact from the time you are referred for a transplant evaluation throughout your care here. They will help answer any questions you may have and assist you throughout your transplant experience.

These professionals meet with you to evaluate your psychological readiness for transplantation.

A transplant pharmacist works specifically with patients who have received a transplanted organ. This pharmacist has been trained to understand details about anti-rejection medications, works closely with your transplant physician to help manage your medications and helps answer medication questions you may have.

The pharmacy patient assistance coordinator offers assessment, linkage and referrals for assistance to patients who need certain medications and have high co-pays or no prescription drug coverage.

Contact: 800-626-2538

The list of accepted insurances for liver transplant can often change. Please contact your health care insurance provider to confirm your coverage for transplant at Ohio State’s Comprehensive Transplant Center.

Ohio State's Tissue Typing Laboratory ensures that an organ is compatible with its recipient. The process involves matching a person's unique configuration of six human leukocyte antigen (HLA) molecules with a potential pool of approximately 100 different varieties.

Cross-match testing helps prevent some types of organ rejection. The testing involves mixing cells from the donor's and recipient's serum to determine whether rejection-promoting antibodies will occur. This information helps your physicians plan for the right medication strategy to best control organ rejection.

Transplant support testing includes monitoring new drugs that patients use, testing to determine a patient's overall ability to maintain a recipient's organ and developing new tests to support many of the clinical aspects of transplantation.

Organ transplant affects a person’s body, spirit and life in numerous ways. Adjusting to these changes can often be easier with the assistance of others with similar experiences.

Open to all Ohio State’s abdominal transplant recipients AND waitlisted kidney, pancreas and liver patients, Ohio State’s Abdominal Transplant Support Group offers an emotionally supportive community before and after the transplant journey and is one of many additional, optional resources offered to benefit our transplant patients. 

• What: Ohio State's Abdominal Transplant Support Group
• Who: Transplant recipients (liver, kidney and/or pancreas) and patients waitlisted for transplant
• Date: Weekly, every Thursday
• Time: 5:30 – 6:30 p.m.
• Location: Virtual - click HERE to join meeting

For questions or concerns, please call the transplant social work office at 614-366-3273.