How do I prepare for my child's transplant evaluation?
Your child's 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. Call us at 800-328-5465. We will then 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 child's coverage. Explain that your child will be having a liver transplant evaluation at the University of Minnesota Amplatz Children's Hospital. This is also a good time to discuss the costs for home care and medicines after the transplant. (Your social worker will talk to you about this during your child's 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 child's medical records. Once we receive your child's records, we will schedule the evaluation. If your child is very sick, he or she may have to stay in the hospital during the evaluation.

What is the goal of the evaluation?
The goal of your evaluation is to decide if liver transplant is the best treatment for your child. We will:

• Check for problems that might occur during or after your child's transplant.
• Gather recent medical information for the surgery.
• Review and adjust your child's diet and treatment so that he or she will be in the best possible condition for a transplant.
• Teach you and your child (if old enough) more about liver transplant surgery, after-care and what to expect while waiting for a transplant.
• Allow you to meet the transplant team.
• Discuss your chid's liver transplant options.

What will happen during the evaluation process?
During your child's evaluation, you will meet with doctors and Transplant Center staff. Your child will also have a number of tests. We urge your family 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 child's evaluation, please let us know.

Doctor consultations
You and your child 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 child's records. If the doctor thinks your child might need a transplant, you will see him or her regularly. The hepatologist will do an exam, then help manage your child's disease.

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

Your child may need to see other doctors as well, including a cardiologist (heart doctor), nephrologist (kidney doctor), endocrinologist (hormone doctor), neurologist (brain doctor) and psychiatrist. Feel free to ask questions at any time.

Blood tests
Your child 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 child's blood type twice.)
• Pregnancy test for young women of childbearing age.
• Tests for certain viruses such as hepatitis A, hepatitis B, hepatitis C and HIV.

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

Scans and X-rays
You child may have:

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

Heart consult
You may meet with a heart doctor (cardiologist). He or she will decide which heart tests your child will need. These may include:

• EKG (electocardiogram). Patches on your child's chest will record his or her heart’s rhythm.
• An echocardiogram. This is an ultrasound of your child's heart. Sound waves create an image of the heart on a video screen, showing us how your child's heart works.

Lung tests
If your child has ever had lung problems, he or she will need special breathing tests (called pulmonary function tests).

Social services consult
You and your child will meet with a social worker during the evaluation. The social worker can describe support services and help with changes that your child and 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.