Each candidate will be seen by a multi-disciplinary group of specialists and each specialist assesses the patients and advises accordingly regarding pre-transplant concerns or post-op management issues that may affect the outcome of the liver transplant. Such evaluations from various specialists give a clear picture of the recipient’s and the donor’s overall health status and to determine if transplant is the best option for the patient. Lastly, it also ensures the best chance of success of the transplant and minimises risks.

These evaluations are usually done on an outpatient basis. Some patients may require inpatient evaluation due to decompensated cirrhosis or acute liver failure. Their pre-transplant management and evaluation will be led by Dr Desmond Wai, ACLDT’s transplant hepatologist. Patients may require therapeutic, as well as, diagnostic measures to improve their clinical and functional status. Patients with fulminant hepatic failure will require expedited evaluation and ongoing joint assessment by Dr K C Tan, ACLDT’s transplant surgeon, and Dr Lee Kang Hoe, ACLDT’S pulmonologist and intensivist, as to the appropriateness and timing for transplantation.

Once it has been determined that the patient needs a liver transplant, a transplant coordinator will help the patient and his/ her family to understand and learn more about the transplant such as :

• Benefits and risks of transplant
• Pre-transplant evaluation/ assessment
• What to expect during surgery
• What to expect after surgery
• Medicines that suppress the immune system

The transplant coordinator also assists in :

• A formal letter to the embassy to expedite visa applications;
• Ambulance services (air or land transport) from origin to ACLDT and back;
• Emergency evacuation;
• Recommendation for accommodation in Singapore for patient and the accompanying family members;
• Immediate hospital admission;
• Discharge planning, on-going medications and subsequent follow-up;
• Answering any concerns or questions the patients might have whilst in the hospital and after discharge.

Recipient’s role in a successful pre-transplant

• Dealing with pre-transplant stress :
  • Talk to your transplant coordinator or the transplant team if you feel depressed or fear the transplant surgery. Our team psychiatrist can help you through your uncertainties. Make sure your family members accompany you so that they can also learn on ways to help you overcome the emotional stress.
• Maintain a healthy diet and nutrition.
• If and when possible, stay active in small ways.
• Refrain from smoking, drinking and/ or substance abuse prior to the transplant

Recipient Assessment

The recipient’s assessment period varies as it depends on the patient’s condition. Specialists’ reviews of the recipient are carried out by the transplant team doctors, including Transplant Hepatologist, Pulmonologist, Intensivist, Cardiologist, Nephrologist, Infectious Disease Physician, Dentist and Dietician.

Investigations that are carried out for the recipient include –

• An extensive series of Laboratory Tests (blood test) that are useful to determine
• liver function
• kidney function
• viral screen
• to test the immune system
• Cardiac Evaluation helps to determine if the recipient is able to go through the major surgery and may reveal heart damage that was previously unsuspected. All or some of these tests will be done at the cardiologist’s clinic :
• Electrocardiogram (ECG) records the rhythm of the heartbeat and is used to find heart disease;
• Echocardiogram shows an ultrasound scan of the heart valves and how well your heart pumps;
• Cardiac Catheterization is required if you are above 50 years of age, diabetic, have abnormal heart tests and/ or have history of heart diseases. During this procedure, the recipient will be sedated and a dye is injected through a catheter in the groin region to highlight blood vessels in the heart.
• Pulmonary Evaluation. Besides taking a X-ray of the chest, this involves monitoring the lungs using 2 different procedures. As the recipient will be on a ventilator after surgery, it is important to have a baseline to determine if there may be difficulties weaning offhe ventilator support.
• Pulmonary function test, known as spirometry, reveals how well the patient’s lungs are working and determine his blood’s capacity to carry oxygen.
• Arterial Blood Gas reveals how your body gets oxygen from the air into the blood. Blood is drawn from the artery and tested.
• An Endoscopy determines the presence of enlarged blood vessels or abnormalities located in the stomach and/ or oesophagus. This is also known as the upper gastrointestinal (GI) series or gastroscopy. The patient will be given light sedative to help them relax and the gastroenterologist will use a flexible scope (camera) to view the oesophagus and the stomach.
• A Colonoscopy is a must for patients above 50 years or if there is a history of bowel disease. The patient will be sedated for this procedure and a flexible scope (camera) is inserted through the rectum and into the colon. This procedure is used to rule out any cancer, abnormal polyps or bleeding.
• Diagnostic Images Studies :
• CT scan of the abdomen is used to look at the size of the liver and the surrounding organs.
• PET scan may be required for patients with cancer. This is to ensure that the cancer has not spread outside the liver (metastatic cancer).
• Bone Mineral Density count is to check on bone mass density and to rule out any existing bone disease such as osteoporosis.
• Renal Function Test - 24 hour urine for CCT and UTP to determine if the kidneys are functioning correctly.
• The Psychosocial Evaluation will help the transplant team to find out how well the recipient can handle stress and to determine if the support system, such as family and friends and they know what to expect during the transplant process.
• A Dental Evaluation is recommended on the basis that untreated dental disease may pose a risk for infection and sepsis.
• All female recipients must have a thorough Gynaecological Examination, especially a pap smear and a breast mammogram done.

Whilst the recipient is undergoing the evaluation, the donor(s) will also be interviewed and undergoes some pre-transplant evaluation so as to ensure a matching healthy liver is available. More details on the living donor, the criteria, the assessment and other pertinent information can be found in the next pages.