The liver is the body's largest internal organ, weighing about 3 pounds in adults. It is located below the�diaphragm�on the right side of the abdomen.
The liver performs many complex functions in the body, including:
Produces most proteins needed by the body
Metabolizes or breaks down, nutrients from food to produce energy when needed
Prevents shortages of nutrients by storing certain vitamins, minerals and sugar
Produces bile, a compound needed to digest fat and to absorb vitamins A, D, E and K
Produces most of the substances that regulate blood clotting
Helps your body fight infection by removing bacteria from the blood
Removes potentially toxic byproducts of certain medications
Liver transplantation�is considered when the liver no longer functions adequately (liver failure). Liver failure can occur suddenly (acute liver failure) as a result of infection or complications from certain medications or it can be the end result of a long-term problem. The following conditions may result in liver failure:
Chronic hepatitis with cirrhosis
Primary biliary cirrhosis (a rare condition where the immune system inappropriately attacks and destroys the bile ducts causing liver failure)
Sclerosing cholangitis (scarring and narrowing of the bile ducts inside and outside of the liver causing the backup of bile in the liver which can lead to liver failure)
Biliary atresia (malformation of the bile ducts)
Alcoholism
Wilson's disease (a rare inherited disease with abnormal deposition of copper throughout the body, including the liver, causing it to fail)
Hemochromatosis (a common inherited disease where the body is overwhelmed with iron)
Alpha-1 antitrypsin deficiency (an abnormal accumulation of alpha-1 antitrypsin protein in the liver, resulting in cirrhosis)
Liver cancer
Evaluations by specialists from a variety of fields are needed to determine if a liver transplant is appropriate. The evaluation includes a review of your medical history and a variety of tests. Many healthcare facilities offer an interdisciplinary approach to evaluate and to select candidates for liver transplantation. This interdisciplinary healthcare team may include the following professionals:
Liver specialist (hepatologist)
Transplant surgeons
Transplant coordinator, usually a registered nurse who specializes in the care of liver-transplant patients (this person will be your primary contact with the transplant team)
Social worker to discuss your support network of family and friends, employment history and financial needs
Psychiatrist to help you deal with issues, such as anxiety and depression, which may accompany the liver transplantation.
Anesthesiologist to discuss potential anesthesia risks
Chemical dependency specialist to aid those with history of alcohol or drug abuse
Financial counselor to act as a liaison between a patient and his or her insurance companies
BRIEF ABOUT THE PROCEDURE
Tests
X-rays, liver biopsy slides and a record of medications are used for pre-evaluation for a liver transplant. To complement and to update previous tests, some or all of the following diagnostic studies are generally performed during your evaluation.
Computed tomography, which uses X-rays and a computer to generate pictures of the liver, showing its size and shape
Doppler ultrasound to determine if the blood vessels to and from your liver are open
Echocardiogram�to help evaluate your heart
Pulmonary function studies to determine your lungs' ability to exchange oxygen and carbon dioxide
Blood tests to determine blood type, clotting ability and biochemical status of blood and to gauge liver function. AIDS testing and hepatitis screening are also included
If specific problems are identified, additional tests may be ordered.
There are two types of liver transplant options: living donor transplant and deceased donor transplant.
Living donor.
Living donor liver transplants are an option for some patients with end-stage liver disease. This involves removing a segment of liver from a healthy living donor and implanting it into a recipient. Both the donor and recipient liver segments will grow to normal size in a few weeks.
The donor, who may be a blood relative, spouse, or friend, will have extensive medical and psychological evaluations to ensure the lowest possible risk. Blood type and body size are critical factors in determining who is an appropriate donor.
Recipients for the living donor transplant must be active on the transplant waiting list. Their health must also be stable enough to undergo transplantation with excellent chances of success.
Deceased Donor.
In deceased donor liver transplant, the donor may be a victim of an accident or head injury. The donor's heart is still beating, but the brain has stopped functioning. Such a person is considered legally dead, because his or her brain has permanently and irreversibly stopped working. At this point, the donor is usually in an intensive-care unit.
The identity of a deceased donor and circumstances surrounding the person's death are kept confidential.
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