July 6, 2009 | As of June 15, 101,898 Americans were in need of an organ transplant, according to the U.S. Department of Health and Human Services. The kidneys, heart, lungs, liver, pancreas, and the intestines are all organs that can be transplanted from one human to another. The liver is unique in that a portion of it can be donated by a living individual rather than the entire organ. This can be done because the liver is the only organ that can regenerate itself. Both the donated segment and the remaining section of the donor liver will grow to normal size within weeks. Living donors are generally family members or close relatives of the patient. Unfortunately, there are many more people who need a liver transplant than there are livers available for donation. Patients are examined by specialists to determine if a liver transplant is appropriate and likely to succeed. If so, they are placed on a national transplant waiting list. This list is prioritized so the sickest people go to the top of the list.

July 6, 2009 | Liver transplantation is needed for patients who are likely to die because of liver failure, which is caused by a number of diseases. The most common of these diseases is cirrhosis, which is the scarring and death of liver cells. Cirrhosis refers to the replacement of normal liver tissue with non-living scar tissue. The process begins with inflammation that is caused by long-term liver disease. After many months or years of inflammation, healthy tissue is replaced by scar tissue. As cirrhosis continues, the liver is not left with enough functioning tissue to function properly. If the process of cirrhosis is not slowed or stopped, the liver will no longer be able to perform its critically important functions. Other conditions that may ultimately require a liver transplant include diseases of the bile ducts, which can cause liver failure if there is a backup of bile in the liver. Patients with liver cancer or hereditary diseases, such as Wilson disease and hemochromatosis, may require a liver transplant.

July 6, 2009 | The process of transplanting a healthy liver is a difficult one, not just because of the organ’s location but also because of its important role in keeping the body functioning at all levels. The liver is a large, meaty organ that sits on the right side of the belly. Weighing about 3 pounds, the liver is reddish-brown in color and feels rubbery to the touch. Normally you can’t feel the liver, because it’s protected by the rib cage. The liver has two large sections, called the right and the left lobes. The gallbladder sits under the liver, along with parts of the pancreas and intestines. The liver and these organs work together to digest, absorb, and process food. The liver’s main job is to filter the blood coming from the digestive tract, before passing it to the rest of the body. The liver also detoxifies chemicals and metabolizes drugs. As it does so, the liver secretes bile that ends up back in the intestines. The liver also makes proteins important for blood clotting and other functions.

July 6, 2009 | After being placed on the waiting list for a liver transplant, the patient is given a score based on the results of their blood work. This is called the MELD score, which means Model of End-stage Liver Disease. For children, it is the PELD score, short for Pediatric End-stage Liver Disease. A computer calculates this score. A higher score means the patient is sicker and will be put higher on the list to get a liver. This system is a fair one since it gives livers to the sickest people on the waiting list. The score, and when you get a liver, has nothing to do with who you are, who you know, how long you have waited on the list, or the hospital where you will have your operation. The liver is offered to the transplant team of the first person on the list. Often, the top patient will not get the liver for one of several reasons. When a patient is selected, he or she must be available, healthy enough to undergo major surgery and be willing to be transplanted immediately.

July 6, 2009 | The outlook for liver transplant patients is often expressed as a five-year survival rate. This refers to the percentage of liver transplant patients who are still alive five years after their transplant. The five-year survival rate for liver transplant patients is about 75 percent. Patients who receive livers from living donors have a slightly higher survival rate than patients whose livers came from deceased donors. Most patients can return to a normal or near-normal lifestyle six months to a year after a successful liver transplant. Maintaining a balanced diet, getting regular exercise and staying on prescribed medications are all important ways to stay healthy. A liver transplant patient can expect to take certain number of medication after their surgery, many of them for the rest of their life. Drugs called immunosuppressants prevent the immune system from attacking the new liver while other drugs will help reduce the risk of serious complications after the transplant.