The transplant coordinator and transplant hepatologist are the key individuals who facilitate this evaluation and educate the patient and family members. A comprehensive evaluation is required to determine if absolute or relative contraindications are present and to define the current status of systemic diseases. All outside medical records and liver biopsy materials are reviewed. Patients also have routine electrocardiogram and undergo pulmonary function testing if there is a history of lung disease. PPD testing for tuberculosis is routinely performed.
Renal function is assessed by creatinine clearance.
Doppler of carotid of peripheral vessels may also be appropriate. Consultations with a social worker, financial counselor, and psychiatrist are routine in most centers. Cancer screening with pap smear, mammogram, fecal occult blood testing, and flexible sigmoidoscopy, depending upon age and gender, is completed. Once the pretransplant evaluation is complete, the patient is presented to the Liver Transplant Selection Committee made up of the entire transplant team, including consultants, for categorization and prioritization. Patients who are approved for liver transplantation by the selection committee are then listed for a donor organ with UNOS, and final approval by the insurance carrier or third party payer is sought.