Who can have a liver transplant?

Most people who need a liver transplant suffer from long-term liver disease (cirrhosis) that is advanced and irreversible. Usually you have liver disease for months or years before symptoms occur. Not everyone with cirrhosis needs a transplant and many people can live active lives with mild forms of liver disease.

Sometimes liver disease develops quickly following an infection with a virus or contact with toxic chemicals/drugs. Occasionally, you need an urgent liver transplant when liver failure occurs over a few days.

Once your GP or specialist decides that you are sick enough to need a liver transplant, they will refer you to us. We accept referrals from Victoria, Tasmania, southern New South Wales and other states as indicated. Once you are considered eligible for a liver transplant you be assessed for a liver transplant.

Being assessed for a liver transplant

If you are unwell enough to need a liver transplant, you will then go through the liver transplant assessment process. You will have a variety of tests and consultations to see if you're suitable for a liver transplant.

These include tests of your physical health (such as heart and lung function), psychological wellbeing and social supports. All these factors are taken into account in determining whether a liver transplant is a your best option.

During this period, you and your family will receive education about liver transplantation including the risks and responsibilities. This is to help you make an informed decision about accepting transplantation as an option.

Liver transplant waiting list

After the assessment, if you are suitable for a liver transplant you will be activated on our liver transplant waiting list. Your details will entered onto a confidential national registry and our local transplant waiting list.

The waiting period is a difficult time for most patients. It may last just a few days or stretch to many months. The average wait is eight to 12 months.

Donors

Most organs for transplant are obtained, with family consent, from people who have died following a serious brain injury. By law we cannot share the identity of your organ donor's family with you. In some cases a part of the liver may be donated from a living relative to a child.

Donation after brain death

The majority of our donated livers come from people who have suffered acute structural brain damage, which has resulted in brain death. Brain death is defined as the irreversible loss of brain function. These donors are usually previously well individuals who have died as a result of an accident, a brain haemorrhage or from another cause of brain injury.

Donation after cardiac death

Another source of donated organs comes from those who donate organs after a person's heart has stopped beating. This is known as donation after cardiac death (DCD). Livers from DCD donors increase organ availability by approximately 10%.

Living related donors

Under certain circumstances it may be possible for an adult to donate a portion of their liver to a child. These donors must be either a relative to the child or someone known to the family. Some transplant units perform adult to adult living donor liver transplantation however this is not a procedure which is done by our unit. 

Following the identification of a suitable donor, consent for organ donation is sought from the family. The donor would be in an Intensive Care Unit in any hospital in Australia or New Zealand. This process is managed by organ donor co-ordinators from DonateLife. The final decision to donate rests with the family. Organs considered for donation include the heart, lungs, kidneys, pancreas, intestines and the liver. Sometimes tissue is also donated.

How do you decide who receives the donor liver?

Once donor consent has been given, the donor liver is offered to the local state liver transplant unit. If the originating state is unable to use the liver, the organ is referred on to the other transplant units in Australia on a rotational basis. A recipient is matched from our liver transplant waiting list based on blood group, size and priority. Priority is determined using the MELD score (a computer generated number calculated using blood test results) and clinical assessment of liver disease severity. Occasionally a liver will be offered interstate for a patient with severe liver failure in intensive care and requiring urgent transplantation.

Success rate

In 2009, the 1 year survival rate for liver transplants was approximately 93% and the 5-year survival rate was 86%.

Post Transplant Complications

A liver transplant is a major operation and there are significant risks and complications. Risks vary for individual patients, and depend on a number of factors such as age and general health.

The major risks of liver transplant surgery include:

• Bleeding during your surgery
• The new liver not working
• A blood clot in the artery to the liver which may result in the liver failing
• Kidney failure requiring temporary dialysis
• Heart complications
• Unexpected transmission of other diseases from the donor
• Death (there is a 1 in 100 risk of dying during the transplant operation)

Long term risks after a transplant include:

• Your body rejecting the new liver
• Infection
• Bile duct narrowing (strictures)
• Your disease coming back

There are various side effects of the immunosuppressive therapy required to prevent the body from rejecting the new liver. These most commonly include high blood pressure, diabetes, impaired kidney function, skin cancers and osteoporosis.

Post transplant care

Post transplant patients are seen regularly in the post transplant clinic after going home.

The routine clinic days are Monday and Thursday between 7:30am and 11:30am.

In the clinic, medication doses will be reviewed according to liver function blood tests, and scripts will be provided.

Post Liver Transplant patients who are unwell during office hours must contact a post liver transplant nurse on 03 9496 5353. 

Outside of office hours the Liver Transplant registrar can be paged through the hospital switchboard on 03 9496 5000.