National Liver 

Transplant Guide
National Liver Transplant Guide

Welcome ...................................................................................... A-1

Transplant Team .......................................................................... B-1

Basics ............................................................................................ C-1

Evaluation Process ..................................................................... D-1

Listing Process ............................................................................ E-1

Nutrition ...................................................................................... F-1

Surgery ......................................................................................... G-1

Complications/Medications ..................................................... H-1

Houston Transplant Center ..................................................... I-1

Nashville Transplant Center .................................................... J-1

Pittsburgh Transplant Center .................................................. K-1

Portland Transplant Center ..................................................... L-1

Richmond Transplant Center .................................................. M-1

My Local VA Facility ................................................................... N-1

Patient Testimonials ................................................................... O-1

Resources .................................................................................... P-1

Daily Planner ................................................................................. Q-1

Acknowledgements ...................................................................... R-1

Table of 

Contents
Page A-1

Welcome

Welcome

Your provider has determined that 

your liver disease is severe enough that 

a referral for consideration of liver 

transplantation is appropriate.

Your transplant guide is designed to be 

a reference and to help answer some 

of the questions about the evaluation, 

transplantation, and post-transplant 

period. There is space for notes and 

pockets to hold information. You may 

want to bring this with you to your 

clinic visits during the work-up for 

transplant and during follow-up, while 

you wait for your transplant evaluation. 

Your providers may want to use this to 

teach you about your care. Remember, 

you are the most important part of the 

transplant team.

For those who are accepted for 

continued evaluation at the transplant 

center, some of this same information 

will be given to you at that visit. The goal 
Page A-2

Welcome

of this booklet is to help you understand 

the process (it is complicated!) before 

you arrive at the transplant center 

for the final stages of the evaluation. 

We hope it will provide you and your 

support person(s) with an overview 

of the entire process from evaluation 

to the surgery and aftercare and alert 

you to some of the issues unique to 

transplantation that may arise. We 

also hope it will help you make sure 

that the possibility of a transplant is the 

right decision for you (and your family/

support person).

There are a great many 

acknowledgements that need to be 

made with regard to this book – most 

importantly, however, it was reviewed 

and edited by a number of patients 

(from the Seattle Liver Transplant 

Support Group) whose suggestions were 

invaluable. It is a book written for you 

by knowledgeable providers and others 

who have actually gone through the 

process. The result is a book that they 

felt would have better prepared them 

for what lay ahead. We hope you, too, 

find it a valuable resource. While some 
Welcome

of the language in this book may seem 

“too technical”, most of us (including 

the post-transplant individuals who 

reviewed this) felt that the language was 

necessary since transplantation is a big 

responsibility requiring knowledge of 

specific terms and concepts. “Better to 

start now,” they all said, so here it is.
Transplant Team

Page B-1

Transplant 

Team

Your care as a transplant patient is 

approached as a team. You are an 

important part of the team. Other 

members of the team include the 

transplant surgeons, hepatologists, house 

staff, advanced practice nurses, transplant 

coordinators, social workers, dietitians, 

pharmacists, psychiatrists, psychologists, 

research coordinators, and pastoral 

counselors. While you await your 

transplant, your Hepatology provider 

(or in some cases, your Primary Care 

Provider) and others at your local VA 

are the team members you will work 

with until you go to your designated 

transplant center. These are the 

people who can answer your concerns 

and questions during the transplant 

evaluation and later when you are 

awaiting your transplant. 

Team Members

As part of the transplant process, you 
Transplant Team

Page B-2

will have a team of specialists and 

support working with you. This team 

may include some or all of the follow 

people:

• Transplant surgeon – this is the 

specialist who will perform your 

transplant operation. He or she 

is trained specifically in transplant 

surgery. The surgery team will follow 

you daily after your transplantation.

• Hepatologist – this is a specialist 

trained in the study of liver disease; 

he or she is also trained in the 

medical aspects of transplantation and 

often follows you after surgery along 

with the surgeons.

• House Staff/Residents and GI/

Hepatology Fellows – these are 

physicians who are still in training and 

work under the supervision of the 

transplant surgeon and hepatologists; 

they are an integral part of the team. 

They are available to care for you on 

a 24-hour basis while in the hospital.

• Clinical Nurse Specialist/Practitioner 

– an Advanced Practice nurse who 
Transplant Team

Page B-3

will assist in your care.

• Transplant Nurse Coordinator – is a 

nurse who coordinates all elements 

of your care; he or she will teach 

you how to take charge of your 

own care and will help communicate 

your questions and concerns to the 

team during the evaluation and posttransplant time.

• Registered Nurses (RNs) – the 

nursing staff that will be available 

to assist with your pre- and posttransplant care.

• Physician Assistants – mid-level 

providers who will assist in your care.

• Social Worker – will meet with you 

to discuss concerns about financial 

issues, housing, and also provide 

emotional support. The social worker 

will help you organize the nonmedical aspects of your care and can 

help with referrals to community 

services.

• Dietitian – will work with you to 

develop a nutritional program to 

meet your needs both before AND 
Transplant Team

Page B-4

after transplant in order to maximize 

your health.

• Pharmacist – an integral part of the 

team who helps in managing dosage, 

side effects, and interactions of your 

new medications. The pharmacist will 

assist you and your nurse in educating 

you about your medications prior to 

discharge.

• Psychiatrist/Psychologist – these 

providers can help address any mental 

health issues that come up in the 

transplant work-up and can assist 

you and your caregiver in exploring 

your feelings about the process 

and help with stress management. 

A psychologist or psychiatrist 

also conducts a pre-transplant 

psychosocial assessment that is 

included as part of your application 

package for liver transplant.

• Research Coordinators – these staff 

members conduct research studies 

in order to learn new approaches to 

transplantation. You may be asked 

to participate in one or more of 

these studies. Your participation is 
Transplant Team

Page B-5

completely voluntary; if you decide 

not to participate, it will not affect the 

care you receive.

Your Support Person

One of the most important parts of 

your transplant team is your support 

person(s). You may have more than 

one support person. This may be a 

spouse, parent, close friend, other family 

member, or some combination of these 

individuals. This person’s job is to help 

you during the evaluation process and 

during the critical period of time before 

and after your surgery when you will be 

unable to care for yourself.

Who you choose to be your support 

person is probably the most important 

decision you will make if you are 

going to have a liver transplant. They 

need to be able to provide you with 

mental and emotional support as well 

as physical help during the process. 

This help is crucial for your evaluation, 

transplantation, and recovery.

Your personal support person 

will need to be available at all 

times from the time you are 
Transplant Team

Page B-6

evaluated until about 2 years 

post-transplant. These are some of 

the specific duties your support person 

will have to agree to:

• Go with you to the pretransplant evaluation and followup appointments (unless other 

arrangements are made)

• Assist you with transport to the 

hospital when called in for transplant 

(unless other arrangements have 

been made with the pre-transplant 

coordinator)

• Attend discharge teaching with the 

transplant coordinator and learn the 

information in the discharge teaching 

manual to help you with your selfcare after the operation

•	Help you for 24 hours a day 

for approximately 3 months 

after your discharge from the 

hospital after transplant

• Learn your medications and assume 

responsibility for monitoring the 
Transplant Team

Page B-7

correct administration of medications 

during the early post-discharge period

• Arrange for safe housing for you upon 

your discharge from the hospital

• Transport you (or arrange for safe 

transport) to all clinic, lab, or other 

appointments

As you can see, your support person 

will play a major role during this process. 

We cannot stress enough how vital it 

is to have this personal help. Without a 

support person, you will not qualify for a 

transplant.
Transplant Team

Page B-8

Notes
Transplant Team

Page B-9
Basics

Page C-1

Basics

“What is a liver transplant? 

When do I need one? How 

do people do after one? Who 

pays for it?”

A liver transplant is a medical procedure 

that may be recommended by your 

doctor if you have a significant chance 

of dying from liver disease in the next 

1-3 years. We are born with a liver that 

has many functions needed to maintain 

our health. Sustained injury, over time, 

can lead to decreased function and 

ultimate failure of the liver. There are 

many causes for this, with hepatitis C 

and alcohol being the most common. 

Patients are typically considered for 

transplant when the liver is working 

at roughly 10-20 percent of what is 

considered normal functioning. A few 

patients each year are referred for 

liver transplant on an emergency basis 

for “acute liver failure” – a condition 
Basics

Page C-2

that causes the liver to suddenly stop 

working and can lead to death in 1-2 

weeks.

As you will read, evaluation for a liver 

transplant, receiving a liver transplant, 

and recovering from the procedure 

takes time, commitment, and is unique 

to each patient. The key to a successful 

transplant is the Transplant Team, which 

consists of you (the recipient), your 

caregiver/support person, family and 

friends, and the group of committed 

health care professionals working with 

you.

Definitions

A liver transplant replaces a sick 

(referred to as cirrhotic) liver, or 

a liver with a tumor, with a healthy 

one from someone else. Most of the 

time, a liver is donated from someone 

who has died. This was once called a 

cadaveric donor but is now known as 

a deceased donor. When an organ 

donor dies, the liver is removed by 

a surgeon and sent to the transplant 

recipient as quickly as possible. Livers 

for transplant are matched for body size 
Basics

Page C-3

and blood type.

In rare cases, a living person donates a 

portion of their liver (called a living 

donor). The VA has not provided living 

donor liver transplant as of fall of 2008, 

however, VA policy has changed and 

living donor transplantation is now being 

considered on a case by case basis.

Statistics

According to the United Network for 

Organ Sharing (UNOS), nationwide from 

1988-2007:

• About 6,500 liver transplants now 

occur per year in the US

• Largest age group is 50-64 years old

• Transplant recipients who have 

hepatitis C have slightly lower rates 

of survival than the average transplant 

recipient after 3 years

According to the Organ Procurement 

and Transplantation Network (OPTN) 

for transplants performed between 1997 

and 2004 in the US:

• Survival rate:
Basics

Page C-4

ï 1 year after transplant is 87.7%

ï 3 years after transplant is 79.9%

ï 5 years after transplant is 74.3%

• Because the first liver transplant 

occurred in 1984, long-term survival 

rates are not available.

• Currently (August 2008) there are 

over 16,000 people nationwide 

waiting for a liver transplant, with 

6,493 transplants done in the US in 

the last year.

Combined, the VA Transplant Centers 

(Pittsburgh, Nashville, Portland, and 

Richmond) performed approximately 

100 transplants a year in 2006 and 2007. 

The VA transplant center in Houston 

started transplanting patients in 2008.

When is a liver transplant 

considered?

A liver transplant is considered when 

you might die from liver disease within 

the next 1-3 years. In some situations, 

very severe liver disease may exclude 

you from receiving a liver transplant if 

you are too sick to tolerate the surgery 
Basics

Page C-5

and recovery. You may also be excluded 

if other parts of your body are too 

sick or have cancer. If cancer starts in 

the liver and is found early enough, a 

transplant can still be done and offers 

the best chance at a cure.

Your medical provider may think you 

need a liver transplant if you have 

symptoms of severe liver disease, which 

may include:

• Yellowing of skin or whites of eyes 

(jaundice) 

• Fluid in your belly (called ascites) or 

in your legs (called edema)

• Vomiting blood or passing blood 

in your stool from dilated veins 

(varices) in your esophagus or 

stomach

• Unclear thinking or confusion (called 

encephalopathy) related to the 

build-up of toxins which affect the 

brain

• Changes in your liver tests that 

suggest your liver is working poorly

• Life-threatening bleeding
Basics

Page C-6

• Thinning of your muscles, especially in 

your face, neck, and arms

• Easy bruising or bleeding (due to 

low platelet count or decrease in 

“clotting” protein levels)

To treat these symptoms, you may be 

prescribed a diuretic (or “water pill,” 

which decreases the ascites and edema 

by increasing urination), lactulose

(which gives you diarrhea as it helps 

you get rid of toxins that make you 

encephalopathic) or a beta-blocker

(which lowers your heart rate and blood 

pressure in order to prevent bleeding 

from varices). Occasionally, an antibiotic 

is given to prevent infection in the ascitic 

fluid.

These medications may seem like 

unusual ways of controlling liver failure, 

but they are vital and may extend your 

pre-transplant life. Stopping these 

medications can lead to a rapid decline in 

health, hospital admission, or even death.

Cost

The actual liver transplant (surgery) 

and the seven-day inpatient stay in the 
Basics

Page C-7

hospital usually costs between $150,000 

and $250,000. The cost of medications 

following transplant is about $12,000 

per year (and up to $20,000 per year if 

hepatitis B infection is present). The VA 

covers the cost of evaluation, transplant, 

and medications for eligible Veterans, as 

well as travel to and from the transplant 

center for the Veteran and their support 

person. Some patients whose income 

level exceeds a certain threshold may 

be billed a co-pay for medications and/

or services. In certain circumstances, 

patients receive a transplant outside the 

VA system and then return to the VA 

for follow-up care and medications. This 

service (follow-up appointments/labs and 

medication costs) is covered by the VA 

for eligible Veterans.
Basics

Page C-8

Notes
Basics

Page C-9
Evaluation Process

Page D-1

Evaluation 

Process

“What happens after my 

doctor tells me that I need a 

liver transplant?

The following information is based 

on procedures specific to the VA 

transplant center in Portland, Oregon. 

Recovery and follow-up procedures 

at other transplant centers may be 

slightly different from those in Portland. 

The evaluation process is complex 

and unique to each patient. The 

process begins at your local VA and 

will then continue at the transplant 

center you have been referred to. It 

is extremely important to not miss 

any appointments. Failure to show for 

appointments significantly decreases 

your chance of being accepted for 

transplant. 

Evaluation: First steps

If you decide to use your VA healthcare 

benefits, the first step towards a liver 
Evaluation Process

Page D-2

transplant is getting approval for an 

in-person evaluation at one of the 

VA transplant centers. There are 

five VA transplant centers: Houston, 

Texas, Nashville, Tennessee, Pittsburgh, 

Pennsylvania, Portland, Oregon, and 

Richmond, Virginia. Your evaluation and 

transplant may take place in a city or 

state different from where you live. If 

you are using VA benefits, the VA is 

responsible for you and your support 

person’s travel and lodging to the 

transplant center that you have listed as 

your preference.

This process begins when your referring 

provider (usually a hepatologist, although 

not always) orders tests to evaluate your 

liver disease. If he or she believes you 

would benefit from a transplant, they will 

discuss this possibility with you and your 

support person. Should you decide that 

liver transplantation is something you 

would like to be considered for, you will 

do further tests and evaluations. This 

is called the “transplant evaluation” or 

“work-up.” This does not mean 

you are guaranteed to receive a 

transplant.
Evaluation Process

Page D-3

One of the first steps is often evaluation 

by a psychologist and a social worker 

trained in evaluating patients for liver 

transplantation. Once this is completed 

and they feel you are a reasonable 

candidate from their standpoint 

(remember the importance of social 

support), other medical tests will be 

ordered to make sure you are healthy 

enough to go through with the liver 

transplant operation. These tests include 

evaluation of your heart and lungs (chest 

x-ray, echocardiogram, EKG, pulmonary 

“breathing” tests, cardiac stress test); 

numerous blood tests and further 

evaluation of your liver (abdominal 

CT scan), and a dental evaluation. In 

some cases, the work-up may reveal a 

medical or psychosocial problem that 

would either 1) lead to further testing 

or evaluation or 2) exclude you as a 

transplant candidate.

Once the above is completed and 

you are found to be a reasonable 

candidate by your primary physician 

or hepatologist, the test results are 

assembled and forwarded to the 

VA National Transplant Program in 
Evaluation Process

Page D-4

Washington D.C. as part of what is 

called your “transplant packet.” 

A panel of physicians will review your 

transplant packet. If they decide that 

your condition warrants going further, 

they will assign you to a VA transplant 

center and contact the center about 

your case. The VA transplant center 

will then contact your referring medical 

provider to tell them where and when 

your “in-person” evaluation will take 

place. This process takes roughly one to 

two months from the time your packet 

is submitted to the Transplant Office in 

Washington, DC.

In some cases, the panel may decide to 

defer a decision because they need more 

information first.

The in-person evaluation at the 

transplant center (the final steps of 

the “evaluation process”) usually takes 

approximately one week, although it 

may take longer. Recall that your 

support person(s)/caregiver 

will need to be with you for this 

evaluation. Lodging will be provided 

for you both. You will meet members 
Evaluation Process

Page D-5

of the transplant team. You may be 

given many of the same tests you have 

already taken in order to have the most 

recent information on your current 

health. Your mental and physical health 

will be re-evaluated, and the transplant 

team will ask you questions about your 

home/personal life. You will be asked 

to complete an advance directive, 

which is a written document that tells 

what you want or do not want if you 

become unable to make your wishes 

about health care treatments known. At 

the time of your visit to the transplant 

center, you will also have a surgeon’s 

talk during which the surgeon will go 

over the procedure, risks, and some of 

the issues specific to surgery. You and 

your support person will have plenty of 

opportunity to ask questions during your 

stay there.
Evaluation Process

Page D-6

Notes
Evaluation Process

Page D-7
Listing Process

Page E-1

Listing 

Process

“After all these tests and visits 

- then what? Will I get listed? 

Who makes that decision?”

Who makes the decision about 

transplantation?

Once the final evaluation at the 

transplant center is complete, your 

case is presented to the Selection 

Committee (made up of hepatologists, 

transplant nurse coordinators, transplant 

surgeons, psychiatrists, psychologists, 

social workers, dietitians, and chaplains 

– many of whom you will have met) to 

determine if you meet the criteria for 

transplant. They typically will discuss 

your case the week after you have been 

there. You and your referring provider 

will receive a letter in the mail discussing 

the results of that decision.

Candidacy is determined mostly by the 

following:
Listing Process

Page E-2

• Presence of advanced liver disease 

which cannot be cured by other 

treatments

• At least 6 months abstinence from 

alcohol and illicit substances. The 

patient must demonstrate convincing 

evidence that substance abuse issues 

have been addressed and can be 

determined to be of low risk of 

relapse in the future

• Ceasing any use of any nicotine 

products

• Stable, clean, and sober support 

system

• Full understanding of the transplant 

process

• Ability to demonstrate commitment 

and compliance to your medical care

• No active infections

• No other medical conditions (heart, 

lung, or weight issues) that will 

interfere with the surgery or your 

recovery or long term health

• No active cancer, with the exception 
Listing Process

Page E-3

of some liver cancers

The Selection Committee will then 

decide and inform you and your referring 

provider if you are:

Accepted - You have met all of 

the medical, psychological and social 

criteria and are ready to be placed on a 

waiting list when any pending tests are 

completed.

Deferred - You have some medical 

or psychosocial issues that need to be 

taken care of (dental work, substance 

abuse treatment, ceasing nicotine use, 

improving social support, or further 

heart testing). Being deferred means 

that you need to address the concerns 

brought up during the evaluation before 

you can be re-considered for acceptance 

for listing. There is usually a time limit 

for this to occur. After all concerns are 

addressed, your referring provider will 

contact the transplant center to request 

reconsideration of your case. Your case 

will be re-discussed at their Selection 

Committee Conference where members 

will review how you addressed their 

concerns and will hopefully recommend 
Listing Process

Page E-4

you be approved for listing.

Declined - You may have some medical 

or psychosocial support issues that 

disqualify you from being on the waiting 

list. Sometimes, it is possible that you 

can be re-referred at a later date if some 

of their concerns can be addressed or 

certain medical conditions improve.

The Wait

If you are accepted for transplantation, 

your name is placed on the waiting list, 

according to blood type. It is hard to 

say how long you will have to wait for 

a transplant once you are on the list. It 

could be 5 hours to 5 years. The US 

national average waiting time for liver 

transplantation has increased steadily 

each year, rising from approximately one 

month in 1988 to more than a year in 

1999. Currently, about half of patients in 

the United States wait longer than two 

years for a liver transplant.

During the waiting period, you will 

follow-up regularly with the provider 

who referred you to the transplant 

center. The provider will be responsible 

for your care, checking your blood 
Listing Process

Page E-5

tests, and reporting to the transplant 

center if your condition changes. It is 

always a good idea for you to contact 

the transplant center as well with any 

concerns or questions that may be 

better addressed by them. If you wait 

more than a year, the transplant center 

will likely bring you in for a clinic visit 

to touch base with you, answer any 

questions, and review the status of your 

overall health.

How do transplant centers 

decide who gets transplanted 

first?

In the United States, the federal 

government is responsible for 

regulating the listing of patients and 

the allocation of organs. The method 

for determining this is complicated. 

As part of this process, the Organ 

Procurement and Transplant Network 

(OPTN), administered by a non-profit 

organization, the United Network for 

Organ Sharing (UNOS), has developed 

a system for determining which patients 

waiting for liver transplant should have 

priority. This system, called the MELD 

Score (Model for End Stage Liver 
Listing Process

Page E-6

Disease), is based on statistical formulas 

that predict which individuals are most 

likely to die over the next 3 months 

from their liver disease. The number 

is calculated by a formula using three 

lab tests (bilirubin, International 

Normalized Ratio (INR), and 

creatinine) that are routinely checked 

each time you see your provider for 

follow-up. These labs tell us how your 

diseased liver is doing. The MELD 

usually varies with each lab draw. Lab 

work needs to be drawn every three 

months and sometimes more frequently 

depending upon how sick you are from 

liver disease. Generally those with the 

sickest livers (highest MELD scores) 

will be prioritized. Patients with liver 

cancers who meet transplant criteria 

also receive higher priority.

Your Waiting Time

While you wait, continue to take your 

medications as prescribed. Maximize 

your health. Follow recommended 

nutrition, exercise and lose weight 

if needed. Exercise, walk, and try to 

keep up some social activities. Keep 

all doctors’ appointments. Make sure 
Listing Process

Page E-7

your doctor and the transplant center 

know of any health changes. Though 

you may feel too sick to be active, you 

will have to push yourself to keep active; 

even short walks will help. It is very 

important not to lose too much muscle 

mass since the surgery is more risky if 

you are malnourished. Set up childcare 

or guardianship, if needed; make plans 

for your pets, if needed. If you have 

concerns about your physical limitations 

and exercise, discuss it with your medical 

provider. If you notice a change in your 

health, you need to let your medical 

provider and the transplant center know 

as soon as possible.

Notification

When your name has come to the top of 

the waiting list, a transplant coordinator 

will notify you by phone/pager to come 

to the transplant center. Once you are 

at or near the top of the list, you may 

need to reside near the transplant center 

for up to 2-3 months since you will need 

to be at the transplant center within 6 

hours from the time you are called for 

transplant. The transplant center will let 

you know if this is the case.
Listing Process

Page E-8

Notes
Listing Process

Page E-9
Nutrition

Page F-1

Nutrition

Patients with liver disease have to make 

changes in their diet in order to adjust 

for decreased liver functioning and to 

maintain their overall health. Nutrition 

recommendations are customized for 

individual patients, both pre- and posttransplant, by the dietitian with the 

Liver Transplant Team after a thorough 

evaluation. The following are general 

recommendations, however, that often 

apply to transplant and liver disease 

patients. 

Pre-Transplant

Protein Malnutrition – Many 

patients with end stage liver disease do 

not eat enough protein. As you prepare 

for a possible liver transplant, it is very 

important that you NOT restrict the 

amount of protein you eat. Patients who 

do not get enough protein start to look 

thin in the arms and chest and begin to 

show indentations in their temples.
Nutrition

Page F-2

An unfortunate side-effect of protein 

consumption is an increase in ammonia 

in the bloodstream, which can contribute 

to encephalopathy (confusion and 

memory difficulties). This makes it 

even more important for you to take 

lactulose as prescribed in order to flush 

the ammonia from your body, while at 

the same time eating a sufficient amount 

of protein in your diet. Good sources 

of protein include poultry, eggs, fish, tofu, 

and soy protein.

Low Sodium – Symptoms of advanced 

liver disease include excess fluid and 

swelling in the belly (ascites) and in the 

legs (edema). A high level of sodium, 

or salt, intake increases the amount of 

water retained in the body, and this can 

make ascites and edema worse. So it is 

very important to stick to a low sodium 

diet, especially when these symptoms 

start to develop. Even if you are not 

currently experiencing ascites or edema, 

you may want to start getting used to 

a low sodium diet now since you may 

have to switch to a low sodium diet later. 

A diet low in sodium has been shown 

to have other health benefits for many 
Nutrition

Page F-3

patients with high blood pressure or 

hypertension.

Weight Control – If you are 

overweight, you should work with 

your providers on a plan to lose 

weight sensibly and slowly, without 

causing malnutrition (especially protein 

malnutrition). Losing excess weight 

decreases the strain on your liver 

and other organs, and will make your 

recovery from surgery easier. You may 

have had some discouraging experiences 

in the past trying to lose weight, but 

shedding even just a few pounds can have 

significant health benefits.

Blood Sugar Control – Eating 

smaller meals more frequently helps 

reduce the risk of low blood sugar. This 

also helps with weight control.

Exercise – Exercise is a very important 

strategy to build up your strength prior 

to surgery. However, your exercise 

program has to be sensible and should 

be discussed with your provider. DO 

NOT lift heavy weights since this can 

strain varices. Walking is likely the 

most appropriate type of exercise for 
Nutrition

Page F-4

you. You may want to see if there are 

any “mall walking” hours at a location 

near your home; these are times when 

the mall is open to the public before 

most stores open. If you have difficulty 

walking or have chronic pain that keeps 

you from walking a significant distance, 

then some type of aquatic therapy can 

help with both building strength and 

controlling chronic pain. There may be 

an aquatic therapy program available 

through physical therapy, and you may 

be able to follow up on the skills you 

learn at a pool near your home. Arm 

strengthening exercises are also good to 

do.

Avoid Herbal Supplements and 

Vitamins – Some herbal supplements 

(such as Kava-Kava) can cause liver 

failure. Since herbal supplements are 

not regulated by the Food and Drug 

Administration or any other agency, it 

may be hard to know the exact dosage 

of a particular substance you are taking 

or the contaminants in the product. At 

this point in your liver disease, it is best 

for you to take only what is prescribed 

by your providers to help prevent any 
Nutrition

Page F-5

injury to your liver. Remember that even 

over-the-counter medications can be 

potentially harmful so check with your 

doctor before taking these.

Post-Transplant

Immunosuppressive Drugs – 

These are the medications taken after 

transplant to prevent rejection. The 

side-effects of immunosuppressive 

medication can be very hard on the 

body. Unfortunately, the combination of 

drugs needed to prevent organ rejection 

can increase the risk of “metabolic 

syndrome,” which is a collection of 

health risks that increase your chance 

of developing heart disease, stroke, 

and diabetes. Taking these medications 

can lead to an increase in your blood 

pressure, cholesterol, blood sugar, and 

weight gain. Heart disease is the leading 

cause of death with post-transplant 

patients after the first three months, so 

proper nutrition after transplant is very 

important to control these changes in 

your body. The transplant pharmacist 

will work with you and your caregiver 

to make sure you understand all your 

medications.
Nutrition

Page F-6

The liver transplant dietitian will conduct 

an assessment with you after transplant, 

and you will get a set of nutritional 

guidelines based on your individual case. 

Eating a healthy diet now will help ease 

the transition to your post-transplant 

diet. A healthy perspective on nutrition 

is to think of food as medicine, as 

important as the medications you will 

take after your transplant. Eat what 

your body needs, as recommended, 

without overdosing on any one thing or 

neglecting any particular food group.
Nutrition

Page F-7

Notes
Nutrition

Page F-8
Surgery

Page G-1

Surgery

When you arrive at the 

hospital - Many tests (blood tests, 

electrocardiogram and chest x-ray) 

will be done the day of the surgery. A 

physician will perform a history and 

physical. Please bring a complete list of 

all your medications. Although you are 

at the hospital, ready for surgery, the 

transplant is not guaranteed until after 

the hospital has seen the donated liver 

and the surgeon has determined that it is 

safe to proceed. 

Surgery prep – This occurs the same 

day of surgery. It includes consenting 

to the surgery and intravenous (IV) line 

placement.

The surgery – Once in the operating 

room, an anesthesiologist needs to place 

a number of tubes, lines, and monitors 

so you can be safely managed for this 

big operation. The next thing you will 

remember is waking up in the Intensive 
Surgery

Page G-2

Care Unit. The surgery lasts anywhere 

from 7 to 12 hours (average). When you 

have recovered sufficiently, you will be 

transferred out of intensive care.

The incision for liver transplantation 

is quite large – it goes across your 

abdomen and may extend up toward 

your chest. Once the incision is made, 

the surgeon will proceed with removing 

your old liver (leaving behind parts of 

the major blood vessels and bile ducts to 

attach to the new liver). While the new 

liver is being sewn in, you may be placed 

on veno-veno bypass to allow 

blood to flow around the site where the 

surgeons are working while returning 

a normal amount of blood back to the 

heart. During the surgery, you will 

receive transfusions of blood products 

and have blood sent for frequent 

monitoring of clotting factors, blood 

counts, and body chemistries. The gallbladder is also removed at the time of 

liver transplant so that it will not cause 

problems later, since performing another 

surgery in that location later would be 

difficult.
Surgery

Page G-3

At the completion of transplant, you 

will be taken to the Intensive Care Unit 

(ICU). You will be kept on a breathing 

machine (ventilator) for a day or so 

and will be followed very closely by the 

staff there. The average length of stay 

in the ICU is one day, after which you 

are transferred to the medical floor/

transplant unit. 

The Hospital Stay and the Clinic 

Follow-Up

Recovery in the hospital

• Typically, you will be in the hospital 7 

to 10 days, but this could be longer 

and will depend upon your postoperative course.

• Expect some restrictions (walking, 

food, weight, visitors), but it will be 

important for you to get out of bed 

and moving soon after your surgery.

ïYou will be able to see visitors as 

soon as you are on the transplant 

floor (visitation policies while on 

the ICU floor vary by facility). 

ïNutrition recommendations will be 

different for each individual; you will 
Surgery

Page G-4

meet with a dietitian so that you are 

well informed of the diet that best 

suits your unique needs. 

• Routine tests and labs will be done 

daily to monitor your progress. 

• You will be ready to leave the 

hospital when you are walking, eating, 

comfortable with/and understand 

your medications and aftercare plan, 

and have your support person(s) able 

to care for you. 

Interim recovery (clinic followup while you are residing at VA 

transplant center lodging)

Once you are out of the hospital, the 

transplant team will assume all aspects of 

your medical care. They can be reached 

24 hours a day.

• Your medical provider will probably 

see you once a week, but this can 

vary as your recovery progresses.

• For the first two to three months, 

you will get your blood tested twice 

a week, but if there is a need for 

more, your transplant coordinator 

will notify you. Your blood tests will 

indicate to your medical provider if 
Surgery

Page G-5

medication adjustments are needed. 

They also show how your body is 

responding to your new liver (even 

before you notice how your body is 

responding).

• For patients transplanted for hepatitis 

C, routine liver biopsies are done at 3, 

6, 12 months and then annually posttransplant to evaluate the severity of 

recurrent hepatitis C.

• Following a liver transplant, some 

people develop conditions such as 

diabetes or irregular chemical levels. 

They need to receive treatments 

to address these problems. All liver 

transplant recipients will be treated 

with medication that stops the body 

from rejecting its new liver. 

• You will begin physical therapy, which 

is a major factor in your recovery. 

Prior to the transplant, your body 

was extremely sick, emaciated, and 

out of shape. Physical therapy will 

assist you in regaining your strength 

for quicker recovery.

Recovery at home

Instructions are given from the liver 
Surgery

Page G-6

transplant team to you, your personal 

support person, and your primary 

medical care provider. They include 

which lab tests to complete and how 

often. You will receive recommendations 

about your visits with your referring 

or primary medical care provider. You 

and your support person will have a 

solid understanding of the medications 

you will need to take. In fact, you may 

feel like a medication expert because 

you will be just as responsible 

for your health care as your 

medical providers are. You are part 

of your own treatment team! Do not, 

however, adjust medications without the 

knowledge of the transplant team.
Surgery

Page G-7

Notes
Surgery

Page G-8
Complications/Medications

Page H-1

Complications/

Medications

Complications

Because several of these possible 

complications occur more often in 

the immediate post-transplant period 

(defined as first 3 months after 

transplant), transplant centers require 

you to remain nearby to allow for 

frequent monitoring by them so they can 

look for these events and take care of 

them quickly.

Related to Surgery:

A liver transplant is a complex process 

that requires hundreds of steps. 

While there are a number of possible 

complications, fortunately most are 

quite rare. One of the reasons you 

undergo so many tests before the 

surgery is to decrease the potential 

risks of heart attack, stroke or death. 

Despite all these tests, it is important to 

be aware that these things can happen. 

Occasionally, the new liver fails to work; 
Complications/Medications

Page H-2

if that happens, the transplant center 

does everything they can to find a new 

liver right away. In addition, one of the 

new anastamoses (connections) 

of the new liver, with blood vessels or 

other structures in the abdomen, can 

develop a complication requiring return 

to the operating room for repair or 

other procedures to open up the new 

connections.

Rejection:

Your immune system helps fight 

infections. It does this by recognizing 

self (your own cells and proteins) from 

non-self (those things that are foreign 

to your body). Anything it sees as nonself is attacked by your immune system 

and destroyed. Your new liver naturally 

is recognized as non-self and is attacked 

by your immune system. This process is 

called rejection. To control this natural 

immune response, your providers give 

you a combination of immunosuppressive 

medications (prednisone, tacrolimus, 

azathioprine, mycophenylate mofetil, 

cyclosporine, and sirolimus). You 

must take these medications for life. 

These medications all have side effects 
Complications/Medications

Page H-3

(discussed later) that often lead to the 

need to take additional medications to 

control them. 

Occasionally, your immune system 

still rejects the liver, and additional 

medications may be added. While it 

is rare to lose your liver to rejection, 

untreated rejection can lead to 

permanent liver damage or even death. 

Rejection is monitored by routine lab 

work and letting your medical provider 

know if you are experiencing any 

symptoms.

Infection:

Because of the immunosuppression 

needed to prevent rejection, you will 

be at increased risk for infections. 

Occasionally, these infections can be 

fatal. There are things you can do to help 

prevent infection such as washing hands 

regularly, avoiding exposure to 

possible airborne fungal spores

(e.g. avoiding smoking marijuana, 

certain occupational exposures), and 

avoiding contact with sick persons. You 

do not need to wear masks after you 

return home.
Complications/Medications

Page H-4

Since the immune system also plays a 

role in fighting cancer, you will be at 

increased risk for developing certain 

types of cancers such as skin cancer or 

post-transplant lymphoma (PTLD). The 

lifetime risk for lymphoma is only 1-2%, 

however, it emphasizes the need for 

good follow-up.

Related to Immunosuppressive 

Medications:

These potent drugs have a lot of 

side effects and potential long-term 

complications. These side effects will 

be monitored at your clinic visits, and 

your providers will make every attempt 

to control or decrease medication side 

effects. Most patients, however, will 

develop one or more complications, 

which then need to be managed.

Diabetes, kidney problems, high blood 

pressure, and high cholesterol are some 

of the more serious side effects. Some 

of the more annoying side effects include 

hair loss, insomnia, diarrhea, nausea, 

headaches, swelling, and neuropathy 

(nerve symptoms).

Do not take any new medications 
Complications/Medications

Page H-5

without talking with the transplant 

center or a physician trained in 

transplant. Many medications can 

interact with each other and cause 

elevated levels of immunosuppression, 

which may lead to serious toxicity. Even 

antibiotics, herbal remedies, ibuprofen, 

and grapefruit can do this!

Medications

When you have a transplant, you will 

need to learn how to plan for your 

medication needs after transplant. You 

will be taking medications every day for 

the rest of your life. You will want to 

know about them as much as possible – 

how to take them, how they work, and 

their side effects.

Your medications are essential to the 

success of the operation and to your 

recovery.

Below, you will find a list of the 

medications you may be taking. There 

will be about 10-15 medications taken 

anywhere from once to four times a 

day. Over time, the number of drugs is 

tapered off so that usually by one year, 

you are taking 2-6 medications every day.
Complications/Medications

Page H-6

• immunosuppressive medications – 

help prevent rejection of the new 

liver; first doses are high and then are 

tapered down; you will take these for 

life

• antibiotics/antivirals – taken for the 

first 3-6 months after surgery when 

the immunosuppression is highest to 

prevent viral/bacterial infections

• antacids – taken to prevent stomach 

upset

• antihypertensives – may be prescribed 

to lower blood pressure

• diuretics (water pills) – may be 

needed to remove fluid

• multivitamins, calcium, and vitamin D

• insulin – occasionally needed to treat 

diabetes caused by the prednisone 

or other immunosuppressive 

medications

• cholesterol-lowering drugs – may 

be started later if you develop high 

cholesterol

• iron – may be prescribed in some 
Complications/Medications

Page H-7

cases if you have low blood counts

• aspirin – may be prescribed if you had 

narrowing or blood clots in any of the 

blood vessels supplying the liver

Other Considerations

• You will need to plan travel carefully 

and consider how you will have quick 

access to medical care if needed. You 

may want to avoid traveling to places 

with high incidence of diseases that 

could be spread through water, food, 

or insect bites.

• You will have many medical 

appointments.

• You will still have hepatitis C (if you 

had it before the transplant).

• You will have a compromised immune 

system because of the medications 

you will take to stop your body from 

rejecting your liver. This means that 

your body will be less resistant to 

fighting off other illnesses.

• You will be discouraged from 

participating in activities that pose a 

high risk to your health.
Complications/Medications

Page H-8

• You will need to take medications 

for the rest of your life and may 

experience unpleasant side effects 

from them. 

• If you are considering having a 

child, definitely discuss this with the 

transplant team prior to conceiving.

• You will feel better

• Food will taste better – watch your 

weight!

• Do not drink, smoke, use drugs – this 

is a lifetime commitment

•	Always keep the transplant center 

informed of your address and phone 

number as they follow you for life
Complications/Medications

Page H-9

Notes
Complications/Medications

Page H-10
Houston Transplant Center

Page I-1

Houston 

Transplant Center

The information in this section refers 

to the Houston Transplant Center 

and is only applicable to you if this is 

your designated transplant site. Please 

remember that each transplant facility 

may handle transplantation differently.

Team Members

Much like at your local facility, your 

transplant facility will have a team of 

specialists working with you on your 

liver transplant. This team includes:

• Transplant Patient and His/Her 

Support Person (family/friends)

• Transplant Surgeon

• Hepatologist

• Transplant Nurse Coordinator

• Social Worker

• Dietitian

• Pharmacist
Houston Transplant Center

Page I-2

• Psychiatrist

• Program Support

Evaluation at Houston

Once you have been approved for 

evaluation at the Houston Medical 

Center by the VA National Transplant 

Program, you will be contacted by 

the nurse coordinator in Houston 

to schedule your evaluation. Your 

evaluation can usually be scheduled 

within two months. You should plan 

to stay for approximately one week, 

although in some cases you may need to 

stay longer for additional testing.

When your evaluation has been 

scheduled, you will receive a packet 

in the mail listing your appointments 

for the week. It will also include basic 

information about the program and the 

lodging unit. You may receive additional 

materials from other departments at 

the medical center, but all scheduling will 

be coordinated through the transplant 

office. Please call the office or your 

coordinator if you have any questions 

regarding the schedule.
Houston Transplant Center

Page I-3

Your referring medical center will 

arrange necessary transportation for 

you and your support person. Our 

social worker will call you one to two 

weeks before your evaluation to give 

you information about lodging, provide 

instructions for your first day of 

appointments in Houston, and answer 

any questions you may have.

Lodging Information

The Houston VAMC has provided free 

lodging at the Fisher House for patients 

and their support person since the first 

evaluation in 2007. The new Fisher 

House includes guest suites with private 

baths, communal kitchen, living and dining 

rooms, a library, a family room and a 

manager’s office.

Local Information

Houston is located in the Gulf Coast 

region of Texas, and has a humid, 

subtropical climate consisting of hot, 

humid summers and chilly, mild winters. 

During the summer months, it is not 

uncommon for the temperature to 

exceed 90 degrees F. During these 

months, light, loose fitting clothing is 
Houston Transplant Center

Page I-4

highly recommended. A bottle of water 

for hydration is also suggested. Summer 

in Houston begins around May-June and 

ends around August-September. During 

the winter months, you can expect 

milder temperatures, averaging a high of 

63 degrees F and a low of 45 degrees 

F. Warm, weather-resistant clothing 

is suggested for winter. Houston also 

receives a high amount of annual rainfall, 

so consider packing a water-resistant 

jacket or umbrella.

The Michael E. DeBakey VA Medical 

Center has a total of three ATM 

machines located throughout the 1st 

floor. There is a two dollar ATM fee for 

all non-members of the Smart Financial 

Credit Union. The Credit Union is open 

Monday-Thursday, 8:30am-4pm and 

Friday, 8am-3:30pm. Only cash, debit and 

credit cards are accepted as forms of 

payment. Checks will not be accepted.
Houston Transplant Center

Page I-5

Contact Information

Houston Liver Transplant Team

Michael E. DeBakey VA Medical Center

2002 Holcombe Boulevard

Houston, TX 77030

Phone: 713.791.1414
Houston Transplant Center

Page I-6

Notes
Houston Transplant Center

Page I-7
Nashville Transplant Center

Page J-1

Nashville 

Transplant Center

The information in this section refers 

to the Nashville Transplant Center 

and is only applicable to you if this is 

your designated transplant site. Please 

remember that each transplant facility 

may handle transplantation differently.

Team Members

Much like at your local facility, your 

transplant facility will have a team of 

specialists and support working with 

you on your liver transplant. This team 

includes:

• Transplant Patient and His/Her 

Support Person (family/friends)

• Transplant Surgeon

• Pharmacist

• Hepatologist

• Registered Nurses

• Social Worker
Nashville Transplant Center

Page J-2

• Dietitian

• Psychologist

• Chaplain

• Clerical Support Staff

You are encouraged to ask questions; 

the physicians and nurses are good 

sources of answers to medical questions. 

The other team members can answer 

your questions within the area of their 

expertise. Trust and rapport provide 

important links between all members of 

the health care team. We must be able 

to work together to treat your disease 

most effectively.

The Facility

The Nashville Transplant Center 

is part of the Tennessee Valley 

Healthcare System. The facility is 

located approximately four miles from 

downtown Nashville, in an area that 

is a combination of residential and 

business and is easily accessible to the 

Metropolitan Transit Authority.

Making Arrangements

The staff from the Liver Transplant 
Nashville Transplant Center

Page J-3

program will contact you to schedule 

your appointment in Nashville for your 

Transplant Evaluation. Plan to stay in 

Nashville for one week, from Sunday 

through Friday.

Local Information

Nashville has a varied climate with 

distinct changes for each season. The 

winter months can range from 20 to 50 

degrees, with a variety of precipitation. 

The summer months average 70 to 

90 degrees and up. Spring and fall are 

usually very mild with a comfortable 

climate.

We suggest that you bring casual, 

comfortable clothing and walking shoes 

for both patient and support persons. 

Don’t forget to bring a jacket, sweater, 

or raincoat as the weather can change 

quickly. Also, it tends to be cool in the 

hospital waiting areas.

There are several banks in the area, 

however without an account they are 

often not willing to cash personal checks. 

You are encouraged to bring travelers 

checks or a debit/check card. There are 

two cash machines within the VA and 
Nashville Transplant Center

Page J-4

several in Vanderbilt.

What to Expect when Listed

We advise that you have either a cell 

phone or alternate number for us to 

use to contact you. Make sure that 

the staff has all of your current contact 

information. Travel arrangements will be 

made with your local VA facility for you 

to fly by Air Ambulance to Nashville for 

your transplant.

It is very important that we have your 

correct contact numbers, as the staff will 

only try to reach you for one hour.

Travelling to Nashville

Normally, patients are seen in Nashville 

after being listed for transplant every six 

months to one year. These visits typically 

last from one to three days.

When you are called for your transplant 

surgery, it is your responsibility to call 

for the Air Ambulance. (They will make 

arrangements for your ground travel 

once you are in Nashville.)

Arriving at the Vanderbilt Facility

Have your ground transport take you 

directly to the Emergency Room. You 
Nashville Transplant Center

Page J-5

and your support person will be taken 

to a room and preparations will begin 

for surgery. Be prepared, as this process 

may take several hours.

After the surgery, you will be taken to 

the Surgical Intensive Care Unit (SICU). 

After a short stay in SICU, you will 

eventually be moved to the Guest House 

Inn.

Lodging Information

While you are in Nashville for your 

evaluation and transplant (if you are 

listed), you will be staying at the Guest 

House Inn. 

When you are discharged from the 

hospital, you return to the Guest House 

Inn. There your surgeons will follow you 

for approximately one month. During 

that time, you will have labs drawn and 

have a visit with your surgeon.

Sample Schedule (for 

Evaluation)

On the next page you will find a sample 

of the schedule you may have while 

you are in Nashville for the transplant 

evaluation.
Nashville Transplant Center

Page J-6

Monday Tuesday Wednesday Thursday Friday

 AM 7 AM 8 AM 9 AM 10 AM 11

NOON

 PM 1 PM 2 PM 3 PM 4

7:30 AM - Report to Transplant CenterLabs #1405113Breakfast from Kitchen to CanteenChest X-RayEKGMeet with Transplant Center Hepatologist2:00 PM - CT Scan

9:00 AM - Psychiatry1:00 PM - Social Work Service

8:00 AM - Meet with ProgramSupport Assistant 8:45 AM - Meet with Surgeon1:00 PM - Meet with Liver Transplant Coordinator

9:00 AM - Psychiatry2:00 PM - Receive Feedback from Psychiatry

7:45 AM - Dietician9:00 AM - Echocardiogram

Sample Schedule
Nashville Transplant Center

Page J-7

Contact Information

Nashville Liver Transplant Team

Tennessee Valley Healthcare System

Nashville Campus

1310 24th Avenue South

Nashville, TN 37212-2637

Phone: 615.327.4751

Toll-Free: 1.800.228.4973

Fax: 615.321.6350
Nashville Transplant Center

Page J-8

Notes
Nashville Transplant Center

Page J-9
Pittsburgh Transplant Center

Page K-1

Pittsburgh 

Transplant Center

The information in this section refers 

to the Pittsburgh Transplant Center 

and is only applicable to you if this is 

your designated transplant site. Please 

remember that each transplant facility 

may handle transplantation differently.

Team Members

Much like at your local facility, your 

transplant facility will have a team of 

specialists and support working with 

you on your liver transplant. Your 

team will offer a multidisciplinary and 

comprehensive approach to your care, 

and will include:

• Transplant Patient and His/Her 

Support Person (family/friends)

• Transplant Surgeon

• Transplant Coordinator

• Physician Assistant

• Administrative Support Personnel
Pittsburgh Transplant Center

Page K-2

• Inpatient Nurse

• Pharmacist

• Nutritionist

• Physical Therapist

• Social Workers

The Facility

The liver transplant program at the VA 

Pittsburgh Healthcare System (VAPHS) 

has been in existence since its inception 

in 1989. At the present time more 

than 475 liver transplants have been 

performed offering a success rate which 

meets or exceeds the national average. 

In January 2004, the VAPHS began the 

first independent, in-house VA transplant 

center in the country. This entailed the 

VAPHS having its own United Network 

Organ Sharing (UNOS) charter for 

liver and kidney transplants. The VAPHS 

independent transplant center’s first year 

proved to be quite successful. Forty liver 

transplants were successfully performed 

between January 10 and December 21 of 

that year. 

The goal of the liver transplant program 
Pittsburgh Transplant Center

Page K-3

is to perform approximately 40-50 liver 

transplants per year. To enhance its 

innovative, independent, liver transplant 

program, the VAPHS hired a team 

of highly experienced and dedicated 

surgeons. 

Evaluation at Pittsburgh

Once you have been approved for 

evaluation at the VAPHS by the VA 

National Transplant Program, you will 

be contacted by the nurse coordinator 

in Pittsburgh regarding your evaluation. 

Your evaluation can usually be 

scheduled within two to three months 

on an outpatient basis. If you are in 

more emergent need of evaluation 

then direct admission to the VAPHS 

for an expeditious work up may be 

required. The usual evaluation time 

frame is approximately one week but 

may be longer if you require extensive 

testing. When your evaluation has been 

scheduled, you will receive a packet 

in the mail listing your appointments 

for the week. It will also include basic 

information about the program and the 

lodging unit. You may receive additional 

materials from other departments at 
Pittsburgh Transplant Center

Page K-4

the medical center, but all scheduling will 

be coordinated through the transplant 

office. Please call the office or your 

coordinator if you have any questions 

regarding the schedule.

Your referring VA medical center will 

arrange necessary transportation 

for you and your support person. 

Payment for the flight(s) are incurred 

by your primary VA. Payment for 

transportation via Yellow Cab from 

the Pittsburgh International Airport 

to the VAPHS will be incurred by our 

facility. Our social worker will contact 

you prior to your evaluation to make 

your lodging arrangements. The cost 

of lodging at one of the various local 

hotels is incurred by the VAPHS. Meals, 

incidentals and phone calls are the sole 

responsibility of the Veteran and/or 

support person. Those Veterans being 

evaluated without a support person 

will be lodged in our Hoptel facility 

located on 6 East within the medical 

center. Most units have single patient 

rooms including private baths, phone, 

bed, TV and desk area. There is also 

a community kitchen and socializing 
Pittsburgh Transplant Center

Page K-5

area. Meal tickets for breakfast, lunch 

and dinner are provided. Patients must 

be able to function independently in 

order to be lodged in the Hoptel unit. 

Individuals must be ambulatory and 

are responsible for bringing and taking 

their own medications along with being 

accountable for paying any out of pocket 

expenses.

Following your transplant evaluation, 

the transplant team determines if 

you are an appropriate candidate for 

liver transplantation. Once listed for 

transplant, the waiting time is best 

estimated by your MELD (Model for 

End Stage Liver Disease) score and 

your blood type. Wait times and 

transportation to the VAPHS when 

a donor becomes available will be 

explained to you in detail during your 

transplant evaluation.

The transplant itself may take 6-12 

hours. You are usually in the intensive 

care unit (ICU) for 2-3 days if you do 

not incur any complications. From the 

ICU, you are transferred to the 6West 

liver unit where surgeons and physicians 
Pittsburgh Transplant Center

Page K-6

assistants continue to monitor your 

progress and make changes regarding 

your anti-rejection medications. You 

can anticipate to stay on the 6West unit 

approximately 10 days to 2 weeks. From 

the hospital you will be discharged to 

the local hotel with your support person 

for a trial of independent living. You will 

continue to have bloodwork done on 

an outpatient basis 2 times per week 

and be seen in the weekly liver clinic 

on Fridays. Following a total of 30 days 

from your transplant and again if you are 

not incurring any complications, you will 

be able to return home. Your primary VA 

will be notified of your post transplant 

recovery period, lab draw frequency and 

post operative medications. You will 

need to return to the VAPHS 4 months 

post transplant for a T Tube removal. 

Again, if you incur no complications 

then you will return to the VAPHS on an 

annual basis. Your transplant coordinator 

is your primary contact at the VAPHS 

and will monitor your condition lifelong.

Local Information

Pittsburgh is located in the western 

region of Pennsylvania, and has a 
Pittsburgh Transplant Center

Page K-7

humid, subtropical climate. The city’s 

climate features abundant precipitation 

throughout the year and four distinct 

seasons. Summer temperatures in 

Pittsburgh can average with highs in the 

lower 80s and lows in the lower 60s. 

The warmest months tend to be July 

through August. Winter temperatures 

average with highs in the upper 30s and 

lows in the 20s.

Pittsburgh receives heavy precipitation 

due to its position near the Alleghney 

Mountains, and as such the city is 

subject to many overcast days. May is 

the rainiest month of the year due to 

frequent thunderstorms. A durable, 

weather-resistant coat or umbrella is 

highly recommended. February is the 

driest month in Pittsburgh, but snowfalls 

are not uncommon and cold-weather 

garments and sturdy, lined shoes are 

recommended.

All major banks can be found in the 

general Pittsburgh area. ATMs can be 

found in the surrounding areas and 

within the VA hospital. Some ATMs may 

require a usage fee.
Pittsburgh Transplant Center

Page K-8

Contact Information

Liver Transplant Division

University Drive C

Phone: 412.688.6155

Fax: 412.688.6942

VA Pittsburgh Healthcare System

University Drive

Pittsburgh, PA 15240

Phone: 1.866.482.7488
Pittsburgh Transplant Center

Page K-9

Notes
Pittsburgh Transplant Center

Page K-10
Portland Transplant Center

Page L-1

Portland 

Transplant Center

The information in this section refers 

to the Portland Transplant Center 

and is only applicable to you if this is 

your designated transplant site. Please 

remember that each transplant facility 

may handle transplantation differently.

Team Members

Much like at your local facility, your 

transplant facility will have a team of 

specialists working with you on your 

liver transplant. This team includes:

• Transplant Patient and His/Her 

Support Person (family/friends)

• Surgeon

• Hepatologist

• Clinical Nurse Specialist

• Pre- and Post- Coordinator

• Social Worker

• Psychiatrist
Portland Transplant Center

Page L-2

• Pharmacist

• Dietitian

• Chaplain

• Facilitator

Evaluation

Once you have been approved for 

evaluation at the Portland VA Medical 

Center by the VA National Transplant 

Program, you will be contacted by 

the nurse coordinator in Portland 

to schedule your evaluation. Your 

evaluation can usually be scheduled 

within two months. You should plan 

your stay for approximately one week, 

although in some cases you may need to 

stay longer for additional testing.

When your evaluation has been 

scheduled, you will receive a packet 

in the mail listing your appointments 

for the week. It will also include basic 

information about the program and the 

lodging unit. You may receive additional 

materials from other departments at 

the medical center, but all scheduling will 

be coordinated through the transplant 

office. Please call the office or your 
Portland Transplant Center

Page L-3

coordinator if you have any questions 

regarding the schedule.

Your referring medical center will 

arrange necessary transportation for 

you and your support person. Our 

social worker will call you one to two 

weeks before your evaluation to give 

you information about lodging, provide 

instructions for your first day of 

appointments in Portland, and answer 

any questions you may have.

Lodging Information

The Portland VA Medical Center has 

provided free lodging on the Vancouver 

campus for patients and their support 

person since the first evaluation in 

1988. A brand new facility, Building 

18, was opened in February 2006, and 

includes 30 double occupancy lodging 

rooms. Each room includes a television, 

refrigerator, telephone and private 

bathroom. Three separate communal 

areas are defined by large kitchens with 

adjacent living rooms warmed by gas 

fireplaces, and opening onto outside 

patios with gas barbecues. Lodgers also 

have on-site access to three laundry and 
Portland Transplant Center

Page L-4

computer rooms, as well as a central 

exercise room.

Local Information

Winter in Portland and the surrounding 

area typically lasts from November 

through March and often includes cloudy 

skies and rain with high temperatures in 

the 40s and 50s, and low temperatures 

in the 30s and 40s. Heavier, warmer, and 

water-resistant clothing is suggested. 

Summers in the region, June through 

September, are often sunnier and offer 

high temperatures in the 70s and 80s 

and low temperatures in the 50s. Spring 

and Fall are transitional. A lighter jacket 

is recommended for some individuals 

during these transitional seasons.

All major banks are located in the 

general Portland area. All types 

of payment are accepted for most 

transactions in the area. ATM machines 

are located by the Canteen Service area 

in the VA facility and payment for any 

bills received can be completed by check.

Support Groups

Support groups can be a great way for 
Portland Transplant Center

Page L-5

you to find support outside of your 

circle of family and friends. Portland 

offers two different support groups. 

Please ask your coordinator for 

information on how to join one, or both, 

of these support groups.

• The Hepatitis C Support Group for 

patients and family members meets 

every 3rd Wednesday from 10:30 am 

until noon at the hospital.

• A support group for transplant 

candidates, recipients and family 

members meets every Wednesday 

at 7:30 pm in the Transplant Lodging 

Unit in Vancouver, WA. 

Note: These times may be subject to 

change. Please verify the meeting times 

with your coordinator.

Sample Schedule

This is a sample of the schedule you may 

have while you are in Portland.
Portland Transplant Center

Page L-6

 AM 8 AM 9 AM 10 AM 11

NOON

 PM 1 PM 2

8:00 AM - Meet Transplant Team8:15 AM - Photo Taken8:30 AM - Pulmonary Function Test9:30 AM - Chaplain Consult10:00 AM - EKG | Business O ce1:15 PM - Liver Clinic

8:30 AM - Substance Abuse Treatment Program Evaluation9:30 AM - Nuclear Medicine/Dobutamine Echo12:30 PM - Bone Density1:00 PM - Echocardiogram1:30 PM - Pre-Transplant Nurse Coordinator

8:00 AM - Social Work Service9:00 AM - CT Scan10:30 AM - Dietician (bring completed questionnaire and support person)

8:00 AM - Psychiatry9:00 AM - Return urine forcreatinine clearance10:00 AM - Surgical Clinic12:00 PM - Take dental antibiotic now1:00 PM - Dental Consult

Wednesday Tuesday Monday Thursday

Sample Schedule
Portland Transplant Center

Page L-7

Contact Information

Liver Transplant Office (P3-TRANS)

VA Medical Center

3710 SW US Veterans Hospital Road

Portland, OR 97239

Phone: 503.721.7860

FAX: 503.273.5072

Portland VA Medical Center

3710 SW US Veterans Rd

Portland, OR 97239

Phone: 503.220.8262
Portland Transplant Center

Page L-8

Transplant Lodging Unit

1601 E Fourth Plain Blvd

Vancouver, WA 98661

Phone: 360.696.4061

Directions

The links provided below can be opened 

in your web browser. Just type in the 

addresses below in your browser’s 

address bar to get directions to the 

Portland VA Medical Center.

http://www.visn20.med.va.gov/portland/

MC/Maps/Portland.asp

http://www.mapquest.com/maps/map.a

dp?zoom=7&address=3710+SW+US+

Veterans+Hospital+Rd&city=Portland&

state=Or
Portland Transplant Center

Page L-9

Notes
Portland Transplant Center

Page L-10
Richmond Transplant Center

Page M-1

Richmond 

Transplant Center

The information in this section refers 

to the Richmond Transplant Center 

and is only applicable to you if this is 

your designated transplant site. Please 

remember that each transplant facility 

may handle transplantation differently.

Team Members

Much like at your local facility, your 

transplant facility will have a team of 

specialists working with you on your 

liver transplant. This team includes:

• Transplant Patient and His/Her 

Support Person (family/friends)

• Surgeon

• Hepatologist

• Clinical Nurse Specialist

• Pre- and Post- Coordinator

• Social Worker

• Psychiatrist
Richmond Transplant Center

Page M-2

• Pharmacist

• Dietitian

• Chaplain

• Facilitator

Evaluation

Once you have been approved for 

evaluation at the Richmond VA Hospital, 

you will be contacted by the nurse 

coordinator in Richmond to schedule 

your evaluation.

When you are ready for your evaluation, 

you will arrive at the Richmond 

airport and take a taxi to the Hospital 

Hospitality House, a hotel-like facility 

near Virginia Commonwealth University 

Hospital, where you will be lodged 

during your evaluation period.

The day after you arrive, you and your 

caregiver will go to the Richmond 

VA Hospital and have blood and urine 

tests obtained from the lab, and then 

report to the Gastroenterology Unit 

(5A-155). The liver transplant nurse 

practitioner and coordinator will be 

there to greet you. You will also meet 
Richmond Transplant Center

Page M-3

with a transplant hepatologist, who will 

take your full history, give you a physical, 

and will provide more details about the 

transplant process.

During the rest of the week, you 

will have additional interviews at the 

Richmond VA Hospital with a social 

worker and psychiatrist or psychologist. 

You will also undergo additional 

diagnostic testing.

Toward the end of your evaluation 

process, you will meet with a transplant 

surgeon at the Virginia Commonwealth 

University Hospital. After you meet with 

the surgeon you will be able to return 

home. The whole process usually takes 

between 3 and 7 days.

After your visit is completed, the 

transplant team will meet to discuss your 

case and make a decision on whether to 

list you or not. You will be notified of 

the team’s decision by telephone, as well 

as by a mailed letter.

Local Information

Richmond has a diverse climate with 

changing and distinct temperatures 
Richmond Transplant Center

Page M-4

in each season. During the winter 

months, the average high temperature 

is 48 degrees F and the average low 

temperature is 29 degrees F. Heavy 

winter clothing and a coat is highly 

recommended. Summer months in 

Richmond average out at a high of 85 

degrees F and a low of 65 degrees F, and 

these months can be very humid. Spring 

and fall months tend to be balmy with an 

average high temperature of 67 degrees 

F and an average low temperature of 44 

degrees F. A light jacket may be required 

for some individuals.

All major banks are located in the 

general Richmond area. All types 

of payment are accepted for most 

transactions in the area. A federal credit 

union with an ATM is located within the 

VA facility.

Contact Information

Hunter Holmes McGuire VA Medical Center

1201 Broad Rock Boulevard

Richmond, VA 23249

Phone: 804.675.5000

Toll-Free: 1.800.784.8381

Fax: 804.675.5585
Richmond Transplant Center

Page M-5

Notes
Richmond Transplant Center

Page M-6
My Local Facility

N-1

My Local Facility

Though your actual liver transplantation 

will take place at a Transplant Facility (i.e. 

Houston, Nashville, Pittsburgh, Portland, 

or Richmond), a significant portion of 

your care and monitoring will still take 

place at your local hospital. Much of 

your initial work-up and pre-treatment 

monitoring will take place at your local 

facility. Your local facility will also take 

part in the care of your liver long after 

your liver transplant.

It is important for you to familiarize 

yourself with your facility and those that 

are caring for you, from your primary 

care doctor to your hepatologist and 

liver transplant coordinator (if he or 

she is at your facility and not at the 

transplant facility).

Use the sections below to keep track of 

this information.
My Local Facility

N-2

My Local Facility Name:

________________________________

My Local Facility Phone 

Number:

________________________________

My Gastroenterology 

Department Phone Number:

________________________________

My Primary Care Provider:

Dr. _____________________________

Ph #: ___________________________

Email: __________________________

My Hepatologist:

Dr. _____________________________

Ph #: ___________________________

Email: __________________________
My Local Facility

N-3

My Transplant Coordinator:

Dr. _____________________________

OR

Nurse __________________________

Ph #: ___________________________

Email: __________________________

Your local facility may have a support 

group set up for patients, who like you, 

are a part of the transplant process, 

either planning to have a transplant, or 

have had one already. These groups are 

very useful and are there to provide 

you with an extra layer of support. If 

your facility has a support group, please 

write down that information below. A 

facilitator is the person leading the group, 

and the coordinator is usually the person 

who handles the set up and day-to-day 

operations for your group. It may also 

be useful for you to jot down the names 

of few support group members that 

you can turn to if you have questions or 

concerns. 
My Local Facility

N-4

My Support Group Facilitator:

_________________________________

Ph #: ___________________________

Email: __________________________

My Support Group Coordinator:

_________________________________

Ph #: ___________________________

Email: __________________________

Name of Support Group 

Member (1):

_________________________________

Ph #: ___________________________

Email: __________________________

Name of Support Group 

Member (2):

_________________________________

Ph #: ___________________________

Email: __________________________
My Local Facility

N-5

For some patients, hepatitis C is a cause 

for their need to have a new liver. If 

this is the case for you, it may be helpful 

to know who at your facility can help 

you manage your hepatitis C, or that 

manages hepatitis C support groups. 

(Please keep in mind that some facilities 

may not have a hepatitis C coordinator.)

My Hepatitis C Coordinator:

_________________________________

Ph #: ___________________________

Email: __________________________

Other Notes:

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________
Patient Testimonials

Page O-1

Patient 

Testimonials

Patient testimonials may have been shortened to fit into 

this booklet.

I was diagnosed with hepatitis C in 1996. I had no idea 

what the disease was or what its treatment was all about. 

At the time, there were no support groups and very little 

in the way of education for Veterans; I didn’t really know 

how to take care of myself (or my liver). After a long 

battle to get help failed, I ended up in liver failure and had 

to be transplanted. Though the process of evaluation for 

transplant was trying and at times, overwhelming, my faith 

and desire to live helped me persevere. My transplant was 

successful and I’m grateful to be alive. While I am limited 

in certain respects, I am able to live a very prosperous life. I 

have found educating and assisting others who struggle with 

liver disease to be very fulfilling.

Gene, Longview WA

Veteran, Transplanted in 2000 

“The best job I’ve ever had was being Amy’s mom. Becoming 

a donor mom was the result of a tragic accident. Amy 

gave so much in her short, almost 18 years and now her 

legacy continues. I am so proud of my daughter and equally 
Patient Testimonials

Page O-2

as honored to be able to speak passionately about the 

importance of organ and tissue donation. In a world so full 

of turmoil, I live in peace and comfort knowing that lives 

have been saved, families spared the pain of loss, sight 

restored and bodies mended. So much good out of one very 

special young lady. Of course, I miss her terribly, but I get to 

brag about her and all the wonderful good she has done. 

How cool is that!” 

Terry, Vancouver WA

Donor Mom

Terry’s daughter Amy passed away in 2000 

I was transplanted in May 2003. With my transplant came 

a few bumps, which are very uncommon in the transplant 

world today. Transplants have changed so much since they 

started that you can be transplanted one year and the 

next year something has changed for the better, either 

with the medications or the procedure. Nine months after 

transplant I went into rejection and developed bad recurrent 

hepatitis C. My condition was so bad that I was approved 

for another transplant, but have not yet needed it. After a 

lot of great doctors and a very positive attitude and some 

crazy changes and combinations of meds I’m doing GREAT 

considering. Through everything I’ve been through since 

I was diagnosed with hepatitis C in 1995, I kept a very 

positive attitude and took one day at a time. Never worried 

about what was going to happen next. I worried about the 

problem when it happened. Most of all this is out of our 
Patient Testimonials

Page O-3

hands and what happens will happen.

Once I was done with all the requirements needed to get 

on the transplant list I started feeling much better. The stress 

was not near as bad. No one person goes through this 

the same. The important things are STAY POSITIVE and do 

everything possible to stay as healthy as possible, even if 

you have a bad day. Remember every day is a different day.

With all that has happened with my transplant and 

knowing how hard it is to receive one plus get through it. I 

would do it again tomorrow.

Paul, Veteran

Selah, WA

When my husband, Wayne, was diagnosed with liver 

disease, I had no idea of the amazing journey we would 

travel together to save his life. Even though I had been 

in the medical field for 30+ years, my knowledge did not 

prepare me for the unrelenting demands upon my time and 

emotions. We began the final road in February of 2002. 

Wayne endured countless tests during the process of being 

evaluated and then accepted for a new liver. By January 

2003, Wayne was critically ill. He had been transported to 

the Portland VA from the Seattle VA. He was on life support 

in the Intensive Care Unit. I lived at the “Liver Lodge” in 

Vancouver, Washington with other family members who 

were waiting, being evaluated or assisting their loved ones 

with recovery. These people became my second family and 
Patient Testimonials

Page O-4

I will treasure their friendship always. We were so blessed 

when the call came to us at 11:00PM on January 30, 2003. 

A liver had been procured and Wayne was scheduled for 

surgery early January 31, 2003. Thanks to the wonderful 

giving of the donor family, Wayne was saved. The recovery 

was long but worth every minute of the struggle. I cannot 

begin to thank all of the wonderful members of the Portland 

Liver Team and the ongoing strength of Wayne’s Seattle 

Hepatologist. Being a “caregiver” is the priority for the 

patient, but without the continued support of our family, 

friends and the entire medical team, I would have lost faith 

many times. The process can be frightening and frustrating, 

but the new life given and to have the person you love 

still with you makes all the battles fade from significance. 

Wayne’s priorities center around his home and all his 

beautiful grandchildren, who are so grateful to have him 

in their lives. We both are avid supporters of the organ 

donor program and are available to help others who need 

assistance, questions answered or a strong shoulder to lean 

on if this journey is one they decide to travel.

Nada, wife/caregiver for Wayne, Transplant 

recipient

Seattle, WA

It has been almost three years since I had my Liver 

Transplant at the VA hospital in Portland, Oregon. The 

most significant thing about a liver transplant, or for that 

matter any transplant, is it changes your perspective on 
Patient Testimonials

Page O-5

life. You tend to have a one day at a time philosophy. The 

second most profound aspect would be my caregiver “wife” 

prior to surgery and post operatively -- because of her 

perseverance and devotion to a headstrong, cranky and 

usually unreasonably demanding individual! Simply put, I 

wouldn’t be here today had it not been for her. Since my 

transplant, I attend a Liver Transplant support group for both 

post-op liver transplants and for individuals contemplating 

whether or not to start the process of qualifying for a 

transplant. These group meetings provide these people 

the opportunity to get important questions answered from 

people who have already been through the ordeal. For 

anyone facing the prospect of getting an organ transplant, 

it cannot be overemphasized that one maintain a positive 

mindset. The entire process is physically, emotionally and 

mentally draining and strong support of family and friends 

is critical for, at the very least a satisfactory recovery. As 

I mentioned above, I wouldn’t be here if not for a very 

generous family of the Donor, my wife and the will to 

survive. I’m generally always available to talk with and 

answer questions for the entire transplant ordeal, and so is 

my wife for anyone contemplating a transplant.

Wayne, Liver Transplant recipient 2003, Veteran

Seattle, WA
Resources

Page P-1

Liver Transplant Contact Numbers and Web Links

Organization Phone Number Web Link

American Liver 

Foundation

1.800.435.4837 www.liverfoundation.org

The Coalition on 

Donation

1.800.330.8620 www.shareyourlife.org

National Transplant 

Assistance Fund

1.800.642.8399 www.transplantfund.org

Organ Procurement and 

Transplantation Network

1.888.TX-INFO-1 www.optn.org

Transplant Patient 

Partnering Program

1.800.893.1995 www.tppp.net

Transplant Recipients 

International 

Organization (TRIO)

1.800.874.6386 www.trioweb.org

United Network of 

Organ Sharing (UNOS)

1.888.894.6361 www.unos.org

Hepatitis C and Liver Disease Web Links

Health Organization Web Link

Federal Health Organization

VA National Hepatitis C Program www.hepatitis.va.gov

Centers for Disease Control Hepatitis 

Branch

www.cdc.gov/ncidod/disease/hepatitis

Health Finder www.healthfinder.gov

Food and Drug Administration www.fda.gov

National Center for Complementary 

and Alternative Medicine

nccam.nih.gov

National Institute of Diabetes, 

Digestive & Kidney Diseases

www.niddk.nih.gov

National Institutes of Health health.nih.gov/result.asp/323

Resources
Resources

Page P-2

Clinical Trials

Organization Web Link

Clinical Trials Registry www.clinicaltrials.gov

Hepatitis C and Liver Disease Web Links

Health Organization Web Link

National Library of Medicine www.nlm.nih.gov

National Institute of Allergy and 

Infectious Diseases

www.niaid.nih.gov/default.htm

Non-Federal Health Organization

American Association for the Study of 

Liver Disease

www.aasld.org

American Gastroenterology 

Association

www.gastro.org

Hepatitis Foundation International www.hepfi.org

National Foundation for Depressive 

Illness

www.depression.org

National Network for Immunization 

Information

www.immunizationinfo.org

World Health Organization www.who.int/health_topics/hepatitis/

en/

Society of Gastroenterology Nurses 

and Associates

www.sgna.org

Patient Support

Organization Web Link

Adverse Event Reporting Program www.fda.gov/medwatch/index.html

Alcoholics Anonymous World Services www.alcoholics-anonymous.org

HCV Advocate www.hcvadvocate.org

Hep C Connection www.hepc-connection.org

Hepatitis Education Project www.scn.org/health/hepatitis
Resources

Page P-3

Travel Information

Organization Web Link

CDC Healthy Travel Information www.cdc.gov/travel/index.htm

Mental Health

Organization Web Link

Center for Mental Health Services www.mentalhealth.org

Mental Help Net www.mentalhelp.net
Daily Planner

Page Q-1

Week of: AM PM

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Week of: AM PM

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

This attached daily planner can be used to organize your day-to-day 

activities and/or times to take your liver medication.

Daily Planner
Daily Planner

Page Q-2

Week of: AM PM

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Week of: AM PM

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday
Daily Planner

Page Q-3

Week of: AM PM

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Week of: AM PM

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday
Daily Planner

Page Q-4

Week of: AM PM

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Week of: AM PM

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday
Daily Planner

Page Q-5

Week of: AM PM

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Week of: AM PM

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday
Acknowledgements

Page R-1

Our dedicated patients, especially Mark Sakura, Paul Orlando, and 

Gene Mask, whose input is everywhere in this book.

Primary authorship: Elizabeth Morrison, MD (VA Puget Sound 

Health Care System) and members of the Portland Transplant 

Program, including: John M. Ham, MD, Anna W. Sasaki, MD, PhD, 

Roberta Ruimy, Ann Busch, RN, MSN, CNS, Domenica McKenna, 

PharmD, Tom Swanson, RN, Kami Faulkner, RN, Sue Gann, Gordon 

Wells, LCSW, Shelly Cowan, LCSW, Marian Fireman, MD, Dorothy 

Brown, Michelle Blum, LCSW

The VA Transplant Center staff at Pittsburgh, Nashville, Portland, 

Richmond, and Houston. 

Brenda S. V. Salvas (Senior Manager, VA National Transplant 

Program)

Northwest Hepatitis C Resource Center: Jason Dominitz, MD, 

MHS (Director), Meaghan Larson, MPH (Program Manager), 

Jeff Paulino (Program Assistant) and the rest of the Northwest 

Hepatitis C Resource Center, VA Puget Sound Health Care System

VA Clinical Public Health Programs Office of the Public Health 

Strategic Health Care Group: Ronald O. Valdiserri, MD, MPH 

(Chief Consultant); Janet Durfee, RN, MSN, APRN (Deputy Chief 

Consultant); David B. Ross, MD, PhD (Director, Clinical Public 

Health Programs); and Jane Burgess, ACRN, MS (National Program 

Manager, QUERI HIV/Hepatitis).

The VA Hepatitis C Resource Centers in Minneapolis, MN 

(directed by Eric Dieperink, MD and Christine Pocha, MD, PhD), 

West Haven, CT (directed by Guadalupe Garcia-Tsao, MD) and 

San Francisco, CA (directed by Alexander Monto, MD).

Acknowledgements
The Transplant Lodging Center in Portland, Oregon

This transplant guide is dedicated to helping veterans 

like yourself by providing information regarding the liver 

transplantation process.

IB 10-259

P96312

December 2009 - Version 1