Having a liver transplant is a huge undertaking. It involves a large team of professionals who are involved from the outset. Liver patients will meet various members of the team at different times during the assessment period. The exact structure of the team will vary from centre to centre, as different hospitals and clinics organise things slightly differently. Some of the team members in a typical team are listed below:
1. TRANSPLANT CO-ORDINATOR
This individual is responsible for all aspects of organising the transplant, waiting lists and co-ordinating the process if a donor is found. This person is therefore your first point of contact for matters concerning the waiting list and transplant operation. The transplant co-ordinator will be responsible for making sure you have all the educational tools you need. He/she will also have a major role in caring for any living donors, arranging their assessments and will be their first point of call too. In short, this very important member of the team is responsible for supporting both recipient and donor throughout the whole transplant process.
2. TRANSPLANT SURGEON
Generally, it is the surgeon who heads the team and ultimately decides that a transplant is required; the timing of the operation (subject to waiting lists); is responsible for making sure all parties understand the operation, risks involved and complications that may arise and actually performs the operation. There are usually 2 transplant surgeons involved at any given operation. One removes the liver from either a live or deceased donor while the other transplants the liver into the recipient.
3. SPECIALIST PHYSICIAN (HEPATOLOGIST)
Most patients are initially cared for by doctors who specialise in diseases of the liver. The Hepatologist may suggest several treatments such as medicines and drugs. A transplant will only be considered if all other measures fail or if the patient has a rapidly progressing liver condition which will not respond to medical measures. Even after this stage, the Hepatologist will be important in deciding how the new liver is functioning and whether the patient and donor have any other medical needs.
4. ANAESTHETIST
This highly specialised doctor is responsible for your well-being throughout the operation. He/she will administer the local and general anaesthetic, monitor your vital signs through surgery and ensure that you wake up after the surgery is complete. Thereafter, it is generally anaesthetists who are in charge of ITU wards. They will ensure that your pain is controlled during this critical recovery period.
5. PSYCHIATRIST
This is a doctor who specialises in mental health. As having a transplant and even more so, donating a portion of your liver, are such emotive subjects and the process is so physically and psychologically demanding, it is the responsibility of the psychiatrist to ensure that the donor and recipient have the insight and knowledge required to make a sound and informed decision. The psychiatrist must also ensure that there is no coercion of either party in making a decision and finally that there are no mental health grounds for suspending the transplant process at any point. Only after this process is complete can a transplant proceed.
6. RADIOLOGIST AND OTHER SPECIALIST DOCTORS
As preparation for transplantation requires several different tests, scans and investigations for both recipient and donor, several other specialists may be involved in the assessment period. After the transplantation has taken place, further monitoring of the liver will of course be required. Chief among these specialists is the radiologist who will most likely be in charge of ultrasound scans, CT and MRI scans and X-rays as required.
7. NURSE
There will be many nurses responsible for many aspects of your care. These range from helping you with aspects of the many tests, investigations and scans that you will need in the assessment phase, to preparing you for the operation and looking after you after you return from theatre to the ward.
8. SOCIAL WORKER
The role of this team member is very varied and depends on place to place. In the UK for example the social worker will generally have many roles. They will discuss with donors the reasons for donating parts of their liver and will discuss the social and emotional issues surrounding donation and transplantation. In addition, they will be able to offer practical advice concerning financial matters, the claiming of benefits and other social issues.
9. PHYSIOTHERAPIST
This member of the team is responsible for many aspects of the rehabilitation process after surgery. Physiotherapy will help in early mobilisation and aid in reducing many potential post operative complications in both recipient and donor. This will hopefully reduce the recovery period and ensure early discharge from hospital.
10. OCCUPATIONAL THERAPIST
This member of the team along with the physiotherapist is responsible for the practical aspects of rehabilitation. Examples of this involve any activity related to self caring (activities of daily living).
11. DIETICIAN
Having undergone such major surgery both the recipient and donor will have specific dietary needs. This applies both in the immediate post operative recovery period and especially for the recipient will also apply over the longer term. This is because chronic liver disease causes many body wide problems. Symptoms such as abnormal weight loss are common. It is therefore not unusual for both recipient and donor to meet a dietician while in hospital.
12. INDEPENDENT ASSESSOR
This person or group of people are not members of the transplant team. In fact it is vital that they are free and independent from the team and have therefore no vested interest in the transplant process. However, legally in many countries a transplantation operation can not proceed without the consent of the independent assessor. The role of this person is to ensure that all procedures and protocols surrounding the recipient and donor are strictly adhered to. They will generally discuss the relevant issues with both parties to ensure that informed consent has been given, fairly, freely and without coercion.
