What to expect from a liver transplant evaluation
A columnist with MASH details the process of her recent reassessment
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After I learned that my metabolic dysfunction-associated steatohepatitis (MASH) had pushed my liver to its limits, I also learned I might someday need a new one. Cirrhosis is no joke. It can creep up quietly without announcing itself. One day, you’re like Templeton, the rat in “Charlotte’s Web,” happily feasting on the spoils of a county fair after the lights go down. The next day, you’re frozen in fear after a phone call from your doctor. It’s disorienting. It’s terrifying.
Once cirrhosis enters the picture, transplant evaluation becomes part of the conversation. I knew I would need to be listed, or at least prepared to be. Thankfully, the United Network for Organ Sharing helps patients navigate that process. If I were critically ill, I might have tried to get listed at every transplant center within a three-hour radius. Instead, I focused closer to home. Living in Baltimore has its perks, and I’m fortunate to be listed at two world-class medical institutions with strong liver transplant programs.
Recently, my transplant coordinator nurse at the University of Maryland — one of the programs where I’m listed — called to tell me it was time to update my records and complete a full reassessment. For transplant patients, this process is thorough by design. Unless you’re too ill to participate, you can expect to spend hours meeting with nurses, doctors, surgeons, social workers, and other specialists. It’s daunting. But when your life and health are on the line, compliance comes easily.
The evaluation process
I started with my nurse coordinator, an upbeat, smart, and compassionate woman who explained the day’s lineup and each person’s role. She reviewed hospital stays, post-transplant monitoring, and how loved ones become part of the care plan. She even announced each new provider as they arrived, like the Ghost of Christmas Present preparing Scrooge for what lay ahead. Dark humor helps.
Next came the surgeon. Tall, charming, and sporting a German accent, he patiently answered my many questions. I’ll admit I was briefly distracted, but his confidence and clarity were reassuring. There is something grounding about meeting the person who might one day save your life with a scalpel.
The social worker followed. This role is critical, especially for patients with limited resources. A transplant requires a village. Some programs won’t proceed unless you have reliable support, and for good reason. Recovery makes everyday tasks, like grocery shopping, feel monumental. I explained that I’m fortunate to have support, even if I tend to attend appointments solo to spare friends the boredom.
After a short wait, I met the head of the program, a kind and attentive physician who asked if a medical student could join us. I always say yes. If my body and experience can help educate a future doctor, I’m all in. We discussed my liver history and abdominal scars from earlier surgeries, including a gallbladder removal when I was just 16. I was surprised to learn that cholecystectomy can increase the risk of fatty liver disease by as much as 54%, according to a 2023 article published in the International Journal of Surgery. It stirred sadness. That surgery wasn’t optional — my gallbladder was dangerously inflamed — but it still felt like a long shadow cast backward in time.
Then came the lab. Transplant evaluations involve extensive blood work — 18 vials, in my case. My veins are notoriously tiny, and despite my best guidance, I walked away feeling like a human pincushion. It wasn’t my favorite moment of the day.
By early afternoon, I was done and eager to get home to my space heater. Before I even crossed my threshold, test results began rolling in. The news was good. The following day, my nurse coordinator called with even better updates: I would remain listed, largely as a precaution. The team felt I was stable and healthy, with my placement reserved for unforeseen events. Even more encouraging, there were signs that my liver fibrosis was slowing and that healthy tissue was beginning to take its place. I squealed with joy.
I share this because knowledge matters. A liver transplant is a major, lifesaving surgery — often a last resort for advanced MASH and cirrhosis. It requires sacrifice, community, and unwavering patient compliance. My sincere hope is that you never need one. But if you do, it’s comforting to know that transplant is usually an option — and that an experienced healthcare team can make all the difference. I know how lucky I am to have mine. I hope you are just as lucky with yours.
Note: Liver Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Liver Disease News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to liver disease.
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