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If you or a loved one is facing liver failure or liver disease, you might have questions or concerns about a potential liver transplant. How long will you have to wait for surgery, what’s involved, who’s your donor, how long does surgery take, and how long will it take to heal are all common questions. To understand everything involved in this life-changing procedure, we spoke with AdventHealth Transplant Institute’s director of Hepatology and the medical director of Liver Transplant Services, Ayman Koteish, MD.
Who’s Eligible for a Liver Transplant?
“To be eligible for a liver transplant, you’ll need to have liver failure, and the burden of living with your current liver needs to outweigh the benefit of the transplant,” says Dr. Koteish. “Your original organ is always best, until it isn’t. That’s when the determination is made by our selection board that you need a replacement organ based on your medical and social evaluation.”
The organ transplant selection committee is comprised of specialists from several different fields including social workers, finance managers, nutritionists, nurses, physicians, and surgeons.
“The selection board needs to establish that you have a support system in place to help during your recovery, are approved through insurance or are financially prepared to cover the cost of the surgery and any medications and lab work before and afterward, and that you’re likely to have good physical function after the surgery,” says Dr. Koteish.
For this reason, the age cap on liver transplant surgery is typically around 69 to 74 years of age. If you’re going to be considered for surgery at that age or potentially older, you’ll need to be in top physical shape and have all your other organs healthy and strong.
“Like athletics, surgery requires a degree of youth,” says Dr. Koteish. “Our first order as physicians is to do no harm to the patient, and as a transplant hepatologist, my second order is to do no harm to the gift of life, which is why the selection process is so stringent. We can’t in good ethics or conscience recommend a liver to someone that stands a risk of being able to sustain it well for years to come.”
Waiting Lists and Organ Donors
Once you have been cleared by the selection committee, you will be placed on the national organ donor computerized waiting list that is broken across regions and states to make sure all organs are allocated in the most optimal condition and in an equitable and fair manner.
Your medical priority, blood type, and body size will determine your length on the waiting list. The wait time for a liver transplant at the AdventHealth Transplant Institute is under a year (which is shorter than the national average). Those with the greatest need are given top priority based on a national scoring protocol called MELD, or Model of End-Stage Liver Disease.
What’s Involved in the Surgery and Recovery?
“Liver transplant surgery generally takes about four hours, but sicker patients take longer to operate on due to potential bleeding,” explains Dr. Koteish. “The liver has more blood vessels than any other organ with two blood supplies flowing to it, and this can complicate the surgery and slow things down.”
After the surgery you’ll be left with a scar in the shape of a hockey stick or a Lexus insignia, or one that looks more like a Mercedes-Benz insignia, so they are often referred to by these nicknames. There will also be drains installed, so the internal wounds can heal properly. The drains are usually removed before you leave the hospital and the staples from the closure are removed in about a week or two after surgery.
Most patients leave the hospital in five to seven days, but sicker patients will require longer stays. The first three months of care are critical to the long-term success of the surgery which is why having a support system is so important.
After those initial three months, medications are usually scaled back and by six months you can be back to work and life as usual. There is a risk of herniating your stomach wall in the first year after the surgery and you should not undertake any heavy or unsafe lifting for that duration. However, most patients report being completely unaware of just how unhealthy they used to feel as compared to how good they feel with a new liver.
Why AdventHealth for Your Liver Transplant?
“We have the #1 liver transplant survival rates in the nation, our culture is one of family and faith and we don’t just treat your disease but your whole health and well-being, as well,” says Dr. Koteish.
“Our state-of-the-art facilities and specialist teams comprised of surgeons, hepatologists, specialized nursing teams, dieticians, and transplant coordinators are dedicated to your recovery. We were also one of 36 health systems selected to participate in the COIIN quality improvement project which is intended to set forth a standard of best practices concerning transplant surgeries and the patient care involved with it.”