Your child's doctor may refer you to the Pediatric Liver Transplant Program at CHOP once she suspects your child needs a liver transplant. Before your child is placed on the liver transplant waiting list, he will need to undergo a transplant evaluation to determine if a transplant is his best option.

The evaluation process is also an opportunity for you and your child to learn more about liver transplantation and to meet the liver transplant team. The evaluation will assess your child's general health, including heart, lung and kidney function, his nutrition, and look for the presence of infection.

What to expect

The pre-transplant evaluation, which is coordinated through the transplant office, is usually done on an outpatient basis over several days. You will be asked to sign a consent form to begin the process to show that you understand the purpose of the evaluation and what is involved. The process begins with a review of your child's medical and surgical history and an office visit with the hepatologist (a physician who specializes in liver diseases) and transplant surgeon.

Your child will also have specific blood tests. His doctor may schedule other tests (such as an abdominal ultrasound) as part of the evaluation process. We may also request an echocardiogram and an EKG.

You will also meet, as a family, with the liver transplant team, including the hepatologist, transplant surgeon(s), nurse coordinator(s), anesthesiologist, transplant social worker, pharmacist, dietician, and financial counselor. The team will discuss your child’s evaluation results with you and explain the surgery, donor options and post-transplant care. This is a good time to ask any questions you may have.

If the team determines a liver transplant is appropriate for your child, you will be asked to sign a consent form so that he or she can be placed on the United Network for Organ Sharing (UNOS) waiting list. The transplant team will also send you a letter to let you know your child has been placed on the list.

Preparing for your child’s evaluation appointment

When you come to the hospital for your first appointment, be sure to bring:

• Any medications your child is currently taking.
• Any X-rays or other imaging studies (either copies or doctor's reports).
• Your child's medical records to date, including physicians' phone numbers and past test results. Copies of these records should also be provided to CHOP before you arrive for your child's appointment.

Your initial evaluation appointment will be in CHOP’s Buerger Center for Advanced Pediatric Care. You can visit our directions page to get door-to-door directions from your area to the hospital. Once you arrive to the Buerger center, go to the sixth floor, in the GI Clinic, for your appointment.

Blood tests

Blood tests help determine how well your child's liver is functioning. Any of the following blood tests may be performed during your child’s evaluation by the liver transplant team:

• Liver enzymes: Elevated liver enzyme levels alert physicians to liver damage because enzymes leak into the bloodstream when the liver is damaged.
• Bilirubin: The liver produces bilirubin, which is excreted in the bile. Elevated bilirubin levels often indicate the liver's bile processing or flow are impaired.
• Albumin:This protein is manufactured by the liver, and below-normal levels are associated with many chronic liver disorders.
• Clotting studies, such as prothrombin time (PT or INR) and partial thromboplastin time (PTT): These tests measure the time it takes for blood to clot. Blood clotting requires vitamin K and proteins, which the liver makes. Liver cell damage and bile obstruction can both interfere with proper blood clotting.
• Your child's blood type: Each person has a specific blood type (type A, B, AB or O). The donor liver ideally would be from a person of the same or compatible blood type.
• Screening chemistry and blood counts: These tests are ordered to assess other organ function and to help direct any further testing that may be needed.
• Viral titers:These tests determine if your child has antibodies to viruses that may cause complications after surgery.

Abdominal ultrasound

An ultrasound is a safe, painless way to take pictures of the inside of the body, using high-frequency sound waves and a computer. Your child's doctor may order an abdominal ultrasound to get a closer look at the liver. Ultrasounds can be done on an outpatient basis.