(Q) HOW IS A TRANSPLANT PERFORMED.

{A} The donor (the person the healthy liver comes from) must have the same blood group as the recipient and should ideally be under 50 years of age. In the case of child recipients it is best if the donor is a child of about the same age. The donor must not have any liver disease or cancer and must not be HIV-positive. In most cases the donor is dead and permission has been given to use his or her liver to transplant into someone else, but in some cases a live donor may give a part of his or her liver for transplantation. The remaining tissue will regenerate new liver tissue. These cases are called ‘split-liver’ transplants.

A liver transplant is a complicated procedure involving at least an eight-hour operation. The diseased liver has to be removed. Connections have to be made to the largest vein in the body (the portal vein that carries blood from the intestine to the liver), to the arteries supplying the liver with blood, and to the intestine for the bile duct which carries bile from the liver to the intestine.

{Q} WHAT DISEASES ARE TREATED BY LIVER TRANSPLANTATION.

{A} A large number of diseases are capable of interfering with the liver's function sufficiently to threaten a persons life. Most are potentially treatable by transplantation. In adults, primary biliary cirrhosis and primary sclerosing cholangitis, chronic diseases which destroy small bile ducts within the liver, are common reasons for transplantation. Chronic viral hepatitis, a disease which destroys liver tissue over a period of years is also important.

{Q} WHAT ABOUT ALCOHOL RELATED DISEASES? .........

{A} Most people who develop cirrhosis of the liver due to excessive use of alcohol do not need a liver transplant. Abstinence from alcohol and treatment of complications will usually allow them to live without the need for a transplant. For those who have abstained for an agreed period of time and whose condition warrants it transplantation may be considered.

{Q} WHAT ABOUT CANCER OF THE LIVER? ..........

{A} Most cancers of the liver begin somewhere else in the body and spread to the liver. These are not treatable with a liver transplant because it would not prevent recurrence of the disease. Tumours which start in the liver have usually spread to other organs by the time they are detected, and are rarely cured by liver transplantation. (for further information on primary liver cancer please contact the British Liver Trust)

{Q} ARE THERE ALTERNATIVE TREATMENTS FOR LIVER DISEASE? ..........

{A} There are effective medicines for some liver diseases, while for others only treatment for complications is available. Often medical treatment delays, but does not eliminate, the need for transplantation.

{Q} IS LIVER TRANSPLANTATION A TREATMENT OF LAST RESORT WHEN EVERYTHING ELSE HAS FAILED? ..........

{A} Yes and no. If medical treatment is likely to allow prolonged survival with good quality of life, transplantation would be reserved for the future. However, ideally the surgery is undertaken before the terminal stage of the disease when the person is too ill to withstand major surgery.

{Q} HOW IS THE DECISION MADE TO TRANSPLANT? ..........

{A} This is a decision made in consultation with all individuals involved in the patient's care, including the patient and family. Their input is vital as they should clearly understand the risks involved.

{Q} WHAT ARE THE MAJOR RISKS?..........

{A} Before surgery, these are mainly the development of some acute complication of the disease which might make surgery too risky. There are also risks common to all forms of major surgery, as well as technical difficulties in removing the diseased liver and implanting the donor liver, and the consequences of briefly being without any liver function at all. Immediately after the operation, bleeding, poor function of the grafted liver, and infection are major risks. The patient is carefully monitored for several weeks for signs of rejection of the liver.

{Q} WHAT ARE THE OVERALL CHANCES OF SURVIVING A LIVER TRANSPLANT? ..........

{A} This depends on many factors such as the age and general health of the patient and also the disease. The exact figure varies from one disease to another and at what stage in the disease transplantation is performed. Survival rates and centre's performing transplantation have significantly increased in the last decade.

{Q} HOW LONG DOES IT TAKE TO RECOVER..........

{A} In part this depends on how ill the individual was prior to the surgery. Most patients spend a few days in an intensive care unit and about two to three weeks in hospital.

{Q} WHERE DO DONATED LIVERS COME FROM?..........

{A} Livers are donated , with the consent of the next-of-kin, from individuals who are brain dead, usually as a result of a head injury or brain haemorrhage. When a donor is identified, transplant centres are contacted by computer network and arrangements are made to retrieve whatever organs may be donated.

{Q} WHAT HAPPENS DURING THIS RECOVERY PERIOD ..........

{A} Initially in the intensive care unit all body functions including liver function are carefully monitored. Once patients are transferred to the ward the frequency of blood testing and other investigations decreases. Normal eating is encouraged and physiotherapy is used to restore muscle strength. Medicine to prevent rejection of the new liver is initially given by injection, but later in tablet form. During the first six weeks after transplantation, frequent tests are done to monitor liver function and detect any evidence of rejection.

{Q} IF A TRANSPLANTED LIVER FAILS TO FUNCTION, OR IS REJECTED, WHAT CAN BE DONE? ..........

 {A} There are varying degrees of failure of the liver, and even with imperfect function the patient will remain quite well. Occasionally a failing transplanted liver can be replaced by a second (or even third) transplant. Unfortunately, there is no dialysis treatment for liver. Whereas a person with kidney failure can be maintained on an artificial kidney machine until a suitable time for transplantation, no such artificial liver is available.

{Q} WHAT SIDE EFFECTS DO PATIENTS COMMONLY EXPERIENCS FROM THE MEDICINES USED TO TREAT OR PREVENT REJECTION?..........

{A} All the drugs used for rejection increase the person's susceptibility to infections (and possibly to the development of tumours). Various medicines are used, and each has its own effects. Cortisone-like drugs produce some fluid retention and puffiness of the face, risk of worsening diabetes and osteoporosis (loss of mineral from bone).Cyclosporin A produces some tendency to high blood pressure, and a growth of body hair. The dose of this is very carefully regulated. Kidney damage can occur from cyclosporin but this can usually be avoided by monitoring the drug levels in the blood. Two new drugs are also being used - Prograf (or fk506) and Neoral (a new presentation of cyclosporin), recently another drug now being used is called Cellcept. Which drug is used depends on a range of factors, including the circumstances of the transplantation, the individual patient's condition and the side-effects best tolerated. Clinicians will discuss the choices with their patient's and ensure the most appropriate immunosuppression for their lifestyle and personal requirements.

{Q} DO RECIPIENTS OF LIVER TRANSPLANTS HAVE TO TAKE THESE MEDICINES FOR THE REST OF THEIR LIVES?..........

{A} Yes. However, as the body adjusts to the new liver, the amount of medicine needed to control rejection is reduced.

{Q} HOW FREQUENT IS THE MEDICAL FOLLOW-UP? ..........

{A} Routine follow-up consists of weekly then monthly clinic visits, including blood tests and blood pressure. Later these tests can be carried out by a local physician with annual or six monthly appointments at the transplant centre.

{Q} ARE PEOPLE WHO HAVE HAD A TRANSPLANT MORE SUSCEPTIBLE TO OTHER INFECTIONS..........

 {A} Patients are advised to take more care to avoid exposure to infections as their immune system is depressed. Any illness should be reported to their doctor immediately and medications should be taken under their doctor's advice.

{Q} WHAT ABOUT PHYSICAL ACTIVITY AFTER A LIVER TRANSPLANT? ..........

{A} Most people are able to resume normal or near-normal activities, and can participate in fairly vigorous physical exercise six to twelve months after a successful liver transplant. Sexual relationships can be resumed when desired.

{Q} CAN THERE BE A RECURRENCE OF THE ORIGINAL DISEASE IN THE TRANSPLANTED LIVER ? .....

{A} This depends on the original disease. Some types of viral hepatitis recur. Other diseases come back less often. This is not necessarily a major problem because of the slow progression of some liver diseases.

{Q} DO THE DONOR AND RECIPIENT HAVE TO BE MATCHED BY TISSUE TYPE, SEX, AGE, ETC ? .....

 {A} No. For liver transplants the only requirement are that the donor and recipient need to be approximately the same size, and of compatible blood types. No other matching is necessary.

{Q} HOW CAN I DONATE MY ORGANS ? ....

{A} You can register your willingness to become an organ donor with the N.H.S. Organ donor register, by picking up a form at your G.P surgery, local library, post office, via your driving licence application or by telephoning Freephone 0800-555-777 or 0845-60-60-400 The register is held at the UK Transplant Support Services Association in Bristol, alongside the national database of people waiting for an organ transplant. It is important to discuss your decision with your family and next-of-kin.

If You would like to be put on the organ donor database please click on link below and it will take you to their website. This will be the greatest gift you will ever give.

                             http://www.uktransplant.org.uk/ukt/how_to_become_a_donor/how_to_become_a_donor.jsp