Candidate evaluation

In accordance with the United Network of Organ Sharing, the VCU Medical Center and the Hume-Lee Transplant Center have developed guidelines to determine which patients may be candidates for liver transplantation. This is based upon a series of laboratory blood tests, X-rays and interviews with members of the liver transplant team.

Tests and procedures

The liver transplant evaluation requires several days to complete. You will receive a schedule that shows an overview of the testing that will be performed during this time. All candidates must undergo dental screening, and all women must have a Pap smear and baseline mammogram. Additional tests include:

  • Lab work: Blood tests are drawn to determine liver and kidney function and to check for possible infectious diseases. Lab tests will be completed to determine liver function, kidney function, prior exposure to viruses that could damage the new liver after transplant and immune system function.
  • Cardiac evaluation: The cardiac evaluation plays a key role in determining if you will be able to safely go through a major surgery such as liver transplantation. Tests include:
    • EKG (electrocardiogram) – a very simple test that records the rhythm of your heart
    • Echocardiogram – an ultrasound to evaluate the valves and functioning of your heart
    • Cardiac catheterization – a procedure requiring sedation that is used to diagnose some heart conditions, which is required for patients meeting any of the following criteria:
      • 50 years of age or over
      • Diabetes
      • Abnormal heart tests
      • A history of heart disease or any heart-related illnesses
  • Pulmonary evaluation: The pulmonary function test involves monitoring how well your lungs are functioning by looking at the oxygen in your blood, while the arterial blood glass test measures the levels of oxygen and carbon dioxide in the blood to determine how well your lungs are working. We will also take a chest X-ray.
  • Duplex ultrasound: The duplex ultrasound gives us a picture of your liver to see if blood is flowing properly. A blockage of your blood vessels could potentially eliminate you from having a transplant. An ultrasound also allows us to screen for cancer, with which certain liver diseases are prone to occur.
  • Endoscopy: This procedure, which requires sedation, is used to determine if you have any enlarged blood vessels or abnormalities, also known as varices, located in your stomach or esophagus. A scope is used to view your stomach and esophagus.
  • Colonoscopy: If you are 50 years or older, you are required to undergo a colonoscopy as part of your testing. You may also need this procedure if you have a history of ulcerative colitis or any type of bowel disease. This procedure uses a scope to view your colon to rule out any cancer, abnormal polyps or bleeding due to abnormal vessels or tissue. You will be sedated for this procedure.

You may have to come back for further testing if there are any questions about preliminary testing. For example, if your echocardiogram is abnormal, you may have to have a more intense stress test or cardiac catheterization.

Preparation for evaluation

Do not eat or drink for six to eight hours prior to the colonoscopy, endoscopy, duplex ultrasound, MRI, cardiac catheterization and/or any type of stress test. Bring an extra supply of all your medications in the event you may have to stay longer than you expect.

Please be prepared to return for further testing in the event something abnormal shows up in your preliminary testing.