- Living Liver Transplantation
- Donor Assessment / Procedure
- Checking into hospital
- The Day / After Surgery
How do I get treatment?
For further information and appointments please see the below contact numbers:
For Mr Rob Hutchins:
020 7234 2940
For the following Consultants:
020 7234 2730
Professor Nigel Heaton
Professor Mohamed Rela
Mr Parthi Srinivasan
Mr Andreas A. Prachalias
Dr Phil M. Harrison
Dr Kosh Agarwal and
Dr Michael Heneghan
Liver Transplant, London.
Liver Transplant Donar Assessment
The process of a liver transplant donar assessment usually takes place over a three week period of time. The donor of a liver will require an extensive assessment to ensure that they are in good physical health with no medical or anaesthetic contraindications to undergoing a partial hepatectomy. We are looking for a donor with normal liver function and anatomy in order for surgery to take place. This process can be terminated at any stage by the transplant team if the donor is found to have a complication with their health screening. The donor also has the option to cancel the process, for whatever reason, at any stage in the assessment.
There will be an initial meeting with a Consultant Transplant Surgeon or Physician to discuss the advantages, disadvantages and various stages of the process. They will require a signed consent form giving permission to take initial blood tests and perform certain investigations on either one of the patients.
Both the patient and donor must be above the legal age of consent i.e. 18 years.
The liver donor will need to have a compatible blood group to the recipient. Any major health issues that the donor has should be raised at this stage e.g. diabetes mellitus, hypertension, recent pregnancies, thyroid complaints, high cholesterol levels or transmittable infectious illness. This meeting is shortly followed by one with a liver transplant co-ordinator. During this meeting, they will describe an overview of the process of assessment and the day of surgery in order to give the patients as much information as possible in order to reach a decision about participation.
The transplant co-ordinator will organise dates and timing for much of the assessment and either at this meeting, or at a subsequent date, they may begin preliminary tests.
The preliminary Liver transplant donar assessment involves:
1. Chest x-ray (to ascertain clear lung fields for the anaesthetic)
2. ECG – electrocardiogram – a painless reading of the heart rhythm to look for any cardiac abnormalities
3. Blood tests. These look copious and will involve about 60ml of blood but will give a clear picture of overall physical health. Most of the blood test results are back as early as 24 hours – others may take a few days longer.
Below is a detailed list of information containing the usual investigations:
1. Differential full blood count
2. Full biochemistry screen – e.g. liver function tests, urea and electrolytes etc
4. Ferritin level
5. Alpha 1 antitrypsin
6. Copper and Ceruloplasmin
7. Full thyroid screen
8. Full lipid screen
9. Blood group – looking for atypical antibodies
10. Hepatitis markers and other virus e.g. CMV, cytomegalovins and Epstein Barr Virus (EBV)
11. Human immune deficiency (HIV) with a written explanation and a signed consent form
12. If applicable – a pregnancy test
NB If the liver transplant donor is on the contraceptive pill she will need to have stopped for at least three months prior to consideration as a donor.
13. Abdominal CT scan (computerised axial tomography). This procedure normally takes about 30 to 45 minutes and sedation or anaesthesia is not usually required. It is a painless procedure and the participant will be able to eat and drink normally before the test. This test gives a cross diction of the hepatic (liver) anatomy to give an accurate measurement of the portion of liver to be donated and to check for any abnormalities deep within the liver.
When all of the tests have been completed and processed, the donor will require review by other members of the London Liver Centre Transplant team. – a Physician, Anaesthetist and a Consultant Psychiatrist.
The Anaesthetist will wish to review the donor separately with all the test results. It is the anaesthetist who will care for the donor during surgery and it is required that the donor has normal heart and lung function prior to the administration of a general anaesthetic which may last from between four to six hours.
Both the recipient and liver transplantation donor will be given an appointment with a Consultant Psychiatrist. He acts as an independent medical source who will ask questions related to psychosocial situation, support mechanisms and comprehension of the process of assessment. It is also his responsibility to ensure that the donor has not been coerced into surgery by any member of the transplant team. He will submit a written report to the medical team and will be available in the future if further consultations are ever required.
At this stage the surgeons may wish to meet the recipient and donor again to review test results and to answer any questions or enquiries that may have arisen from the tests they have undergone or from members of the team they have met in the past few weeks.
The transplant team will do their best to commit themselves to a date booked for this surgery, but if a cadavernic organ is offered to the surgeons on the previous night – in the light of the shortage of organs in the UK, it may be necessary to postpone the elective procedure in order to perform a cadaveric transplant on another recipient on the waiting list.
A summary of the process of Liver Transplant Donar Assessment:
- The suitability of the recipient and donor will first be assessed and then decided by the Surgeons and Physicians.
- Initial Written Consent
- Review by Anaesthetist
- A date will be set by the transplant team, with appropriate notice given
We work to the highest ethical standards and are regulated by the Human Tissue Authority (HTA), and NHS Blood and Transplant (NHSBT). Both of these regulators work under the terms of The Human Tissue Act 2004.
The Human Tissue Authority
(HTA) is an independent watchdog, a public sector authority, independent of the government. Their role is to regulate the use of any living cell for prescribed purposes to ensure that all human tissue is used safely and ethically.
The HTA also gives approval for donations of organs and bone marrow from living people. The HTA is accountable to the Secretary of State for Health in the United Kingdom. .
Legislation: The HTA works under two laws: the Human Tissue Act 2004 (HT Act) and the Human Tissue (Quality and Safety for Human Application) Regulations 2007 (Q&S Regulations).
NHS Blood and Transplant
NHSBT is a Special Health Authority in the NHS with responsibility for optimising the supply of blood, organs, plasma and tissues and raising the quality, effectiveness and efficiency of blood and transplant services.
NHSBT is responsible for:
- encouraging people to donate organs, blood and tissues
- optimising the safety and supply of blood, organs and tissues
- helping to raise the quality, effectiveness and clinical outcomes of blood and transplant services
- providing expert advice to other NHS organisations, the Department of Health and devolved administrations
- providing advice and support to health services in other countries
- commissioning and conducting research and development
- implementing relevant EU statutory frameworks and guidance
Human Tissue Act (HT Act)
The HTA Legislation covers the following areas:
- Informed Consent for Donation
- Prohibition of reward for organ donation – an organ must be given freely
- Enforces rules about which living donors are permitted
- Penalties if coercion is found to be present
There is an Independent Assessor for all organ donation.
Their role is to:
- Act as donor advocate
- Act on behalf of the HTA
The Independent Assessor interviews the donor and recipient independently and also together. They have to be satisfied that there is some evidence of either a genetic, marriage or relationship connection between the recipient and the donor. This process has meant that for more than ten years live non-related transplants have been undertaken successfully.
All transplant units in the UK have to follow both current legislation and so all transplants carried out at London Bridge Hospital will be accompanied by stringent evidence of all the above.
All patients put forward for transplant at the London Bridge Hospital are discussed by a Multi-Disciplinary Team forum, which includes Hepatologists, Anaesthetists, Liver Transplant Surgeons and Transplant Donor Recipient Coordinators. These meetings are held every Friday at Kings College Hospital Liver Unit.
NHS Blood and Transplant: http://www.uktransplant.org.uk/ukt/default.jsp