Transplant Center

To be considered as a candidate for intestinal transplantation, you will first undergo a thorough transplant evaluation. The evaluation will help our transplant team learn more about you and your disease, and provide you with the opportunity to learn more about our intestinal transplant team and program. The evaluation is an important part of the transplant process because it will:

• Confirm your diagnosis and determine the extent of the intestinal injury or disease
• Assess other medical or psychosocial problems affecting your health
• Determine what type of operation is best for you (intestine alone or with other organs)
• Provide information about the risks and benefits of transplantation
• Review your financial benefits and discuss the financial considerations associated with a transplant
• Answer any questions you and your family may have

The transplant evaluation usually takes place over four to five days and is usually done on an outpatient basis unless an inpatient stay is medically necessary. The evaluation includes but is not limited to the following tests:

• Laboratory studies (including HIV testing)
• Chest X-ray
• Abdominal ultrasound
• Electrocardiogram (EKG)
• Radiological tests looking at the length and function of the intestine
• Dobutamine Stress Echocardiogram/stress test if indicated (looks at the blood flow through the heart and heart valves)
• Cardiac Catheterization if indicated

Consultations with the transplant team members including:

• Transplant physician
• Transplant surgeon
• Transplant nurse coordinator
• Social worker
• Dietician
• Psychiatrist
• Psychologist
• Financial Coordinator
• Child Life Specialist
• Other specialists as indicated (cardiology, pulmonary, endocrinology)

Upon completion of the evaluation, your results will be presented at the multidisciplinary transplant team meeting. They will carefully review all the information from the evaluation and give their recommendation of the best treatment option for you. Patients are contacted by a transplant coordinator after the meeting to discuss the plan of care.

Waiting for Intestinal Transplantation

If intestinal transplantation or a combined intestine/liver/pancreas transplant is the best option for you and you are agree, your name will be placed on a national waiting list based on your blood type, body size (height and weight) and medical urgency. Intestinal transplant patients who have had a significant part of their bowel removed prior to transplantation have a reduction in the size of their abdomen. Therefore they may require organs from a donor who is only 50 to 60 percent of their body weight. The waiting time can be a difficult time for you and your family because there is no way to know when a suitable donor organ will become available. Members of the transplant team are always available to you during this time.

Status on the list (medical urgency)

There is a system in place thorough an organization called the United Network for Organ Sharing (UNOS) that ensures all patients in need of transplantation are given a fair and equal chance to receive an organ(s). UNOS is regulated by the federal government which in turn monitors the list and the listing guidelines of all transplant programs.

Patients are listed for isolated intestinal transplant by one or two medical statuses:

• Status 1 is assigned to a patient who has abnormal liver function tests and/or limited IV sites for TPN or other medical indications that make the transplant more urgent such as repeated episodes of dehydration or infection.
• Status 2 is assigned to a patient who does not meet the criteria for Status 1.

Patients requiring a combined intestine/liver transplant are listed through UNOS on both the intestine and liver waiting lists. Adults are listed by a Medical End-Stage Liver Disease (MELD) score and children are listed by a Pediatric End-Stage Liver Disease (PELD) score. The MELD score is calculated using a mathematical formula including three lab values: bilirubin, prothrombin time/INR (measures the livers ability to form blot clots) creatinine (a measurement of kidney function). Currently, sodium also is being collected but not used as part of the calculation. The calculated scores are between 0 to 40 with a MELD score of 40 representing the sickest patient on the list.

The PELD score is calculated using a mathematical formula including four lab values: bilirubin, prothrombin time/INR, creatinine and albumin (another protein made in the liver). The calculated scores are from 0 to 40 with a PELD score of 40 representing the sickest patient on the list.

It is very important that you have lab tests done when requested to be certain the MELD/PELD scores reflect the level of your illness.

During the waiting time some patients may become too sick to receive a transplant (the chance of recovery very poor). If this happens the transplant team may decide to make the patient "inactive" on the list and monitor the patient's progress. If the patient's condition improves, the team may then designate the patient as "active" on the list. Patients are notified of any changes in their listing status.