How do I prepare for my transplant evaluation?
Your local doctor will let you know when it is time to meet with a doctor from the transplant team. He or she will ask you to call us to start the process. When you call us, we will send you a referral packet. At that time, you will need to do the following:

• Read the entire referral packet. If you need help reading or understanding the information, you may call the Transplant Center.
• Complete the Transplant Application in the referral packet. Return it to us in the envelope provided.
• Contact your health insurance provider to ask about your coverage. Explain that you will be having a liver transplant evaluation at the University of Minnesota Medical Center. This is also a good time to discuss post-transplant costs for home care and medicines. (Your social worker will talk to you about this during your evaluation. A financial representative will also be available to talk with you if you have questions about your insurance coverage.)
• Complete the Release of Information form in your referral packet, and return it in the envelope provided. This will allow us to obtain your medical records. Once we receive your records, we will schedule your evaluation. 

What is the goal of the evaluation?
The goal of your evaluation is to decide if liver transplant would be a safe and effective treatment for you. We will:

• Check for problems that might occur during or after your transplant.
• Gather medical information.
• Review and adjust your diet and treatment so that you will be in the best possible condition for a transplant.
• Teach you more about liver transplant surgery, before- and after-care and what to expect while waiting for a transplant.
• Allow you to meet the transplant team.
• Discuss your liver transplant options.

What will happen during the evaluation process?
Your evaluation will consist of several doctor and clinic visits. We urge your family or close friends to come with you. You will receive a lot of information, so please take notes and write down questions. If you do not want to start or continue your evaluation, please let us know.

Drug and alcohol evaluation
If you have a history of IV drug use or heavy alcohol use, you will need to have a formal chemical dependency evaluation. You can arrange for this with your family doctor, or the transplant social worker can explain how to arrange for this. You must follow through with any recommendations from this
evaluation, including further treatment. You must be drug and alcohol free for six months before starting your transplant evaluation.

We may test you for drug and alcohol use at any time. You cannot receive a new liver until you have been alcohol-free and drug-free for one year. You will be asked to sign a contract to show that you agree to this.

Doctor consultations
You will meet the transplant team doctors. Your transplant coordinator may be with you during some of these visits. The transplant hepatologist (liver doctor) will review your records. If the doctor thinks you might need a transplant, you will see him or her regularly. He or she will do an exam, then help manage symptoms related to your liver disease.

The surgeon will explain the operation, possible risks and donor options.

You may also need to see other doctors as well. This might include a cardiologist (heart doctor), nephrologist (kidney doctor), endocrinologist (diabetes/hormone doctor), neurologist (brain doctor) and psychiatrist. Feel free to ask questions at any time.

Blood tests
You will have many blood tests, including:

• Standard tests to measure liver function, protein levels, electrolytes and clotting factors.
• Blood type tests. (We will check your blood type twice.)
• PSA test for men over 50 (to check for prostate cancer).
• Pregnancy test for women of childbearing age.
• Tests for certain viruses such as hepatitis A, hepatitis B, hepatitis C and HIV.

Nutrition check
You will meet with a dietitian. He or she may check your height and weight, then review your blood work to check your nutrient levels. The dietitian may ask you to write down everything you eat or drink for three days. He or she will use this record to measure your routine calorie and protein totals. You may also receive advice about
your diet. Please tell the dietitian if you would like to meet with him or her again.

Scans and X-rays
You may have:

• A chest X-ray.
• An ultrasound of your liver. This test uses sound waves to show us the size, shape and position of your liver. It can also show if there are any unusual growths or tumors. The radiologist (X-ray doctor) will use the ultrasound to check the blood flow to your liver.
• A bone density scan (DEXA scan). This will show how strong your bones are. People with liver disease sometimes have advanced bone disease (osteoporosis). If you have osteoporsis, we may have you take medicine to strengthen your bones before your transplant. Please tell your transplant coordinator if you’ve had this test in the past.
• If you have a liver tumor, we will need to do a chest CT (computerized tomography scan) and a bone scan to see how big the tumor is and if it has spread to other parts of your body.
• Other scans and tests as needed. These may include an MRI (magnetic resonance imaging) and a CT. If you need further tests, we will explain them in detail.

Digestive system check
All patient over age 50 need to have a colonoscopy. If you have never had one, please schedule one with your family doctor and bring the report to your evaluation appointment. If you have had one within the past five years, please have the results sent to your transplant coordinator. If you have vomited blood in the past, please let us know. You may also need to have an edoscopy.

Heart studies
You will have an ECG (electrocardiogram). If you are over age 40 or have a history of heart problems, diabetes or high blood pressure, you will need to have a dobutamine stress echo test. (We will give you medicine to make your heart beat as if you
were exercising. We will then use ultrasound waves to see how well your heart is working.) If you have a history of heart problems or if your tests are abnormal, you will be asked to meet with a heart doctor (cardiologist).

Lung tests
If you smoke or have ever had lung problems, you will need special breathing tests called pulmonary function tests. We require you to stop smoking.

Social services consult
You will meet with a social worker during your evaluation. He or she can describe support services and help with changes that you and your family may need to make in the short-term. Your social worker will also discuss financial concerns and will help you arrange a chemical dependency evaluation, if needed. Anyone who has misused alcohol or drugs will be asked to have this evaluation.

Financial consult
A financial case manager will discuss the costs of both the transplant and the medicines needed afterward. He or she will help you understand your insurance—what it will cover and what it won’t.

Liver cancer
During a medical exam we sometimes find a tumor in the liver. This may be a type of liver cancer. Some liver diseases increase the risk of liver cancer (cirrhosis, viral hepatitis B and C, hemochromatosis). If you have many tumors or large tumors, you may not be eligible for a transplant. In this case, your doctors will discuss your options with you.

You will be asked to meet with a cancer doctor (oncologist) if:

• You have a liver tumor
• We find a liver tumor during your evaluation
• You have ever had cancer of any type