4. Clinical Guidelines for Liver Transplantation (PDF) - British ...

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Guidebook for the Solid Organ Transplant Programme Chapter 4 Liver Transplant Baseline Assessment Appendix P Pt. Name Blood Type:_______________________ Hematology: WBC:_____________________________ Hgb:______________________________ MCV:_____________________________ Platelet :___________________________ INR:______________________________ PTT:______________________________ Chemistry: Na:_______________________________ K:________________________________ CL:_______________________________ CO2:_____________________________ Urea:_____________________________ Creatinine:_________________________ Est GFR:___________________________ Calcium:___________________________ Phosphate:________________________ AlkPhos:__________________________ GGT:_____________________________ CK:_______________________________ AST:______________________________ ALT:______________________________ Total Bili:__________________________ Direct Bili:_________________________ Protein:___________________________ Albumin:___________________________ Glucose:__________________________ Other Results: AFP:______________________________ CEA:_____________________________ PSA:_____________________________ Urinalysis:_________________________ Stools for OB: #1_____#2_____#3_____ TB Skin Test:_______________________ Diagnostic: Antinuclear Ab:_____________________ Antismooth muscle Ab:_______________ Antimitochondial Ab:_________________ Alpha 1 Antitrypsin level:______________ Ceruloplasmin:_____________________ Ferritin:____________ Iron:___________ TIBC:______Fraction Saturation:_______ Genetic Testing: ____________________ Date of Blood work: Virology: DATE CMV IgG EBV IgG HepA Total HbsAg HbsAb HbcAB HbVDNA Hep C Genotpye HSV VZV HIV I &II Ancillary Testing: CXR:__________________________________ EKG:__________________________________ ECHO:_________________________________ US:____________________________________ CT:____________________________________ MRI:___________________________________ Mammogram:____________________________ Dental:_________________________________ Anesthesia:______________________________ Tumor Rounds:__________________________ Tumor Treatment:________________________ MISC. Consults:_________________________ _______________________________________ _______________________________________ Team Consults: Social Work:_____________________________ Psychologist:_____________________________ Nutritionist:______________________________ Pre-Activation Talk:_______________________ Ascites:_____________HE:____________ MELD:____________PUGH:___________ Chapter 4 – Clinical Guidelines for Liver Transplantation – July, 2010 Page 61 See Page 1 for disclaimer
Guidebook for the Solid Organ Transplant Programme Chapter 4 Appendix Q WHEN A LIVER BECOMES AVAILABLE Keep your pager with you at all times and call the Clinical Coordinator on call 24 hours a day at 1-800-663-6189 or (604) 877-2240 anytime your pager goes off. It is extremely important that the transplant team be able to reach you as soon as a liver becomes available. The transplant team should know where to get in touch with you at all times. If an organ becomes available and the transplant team has selected you as the most suitable recipient, the BCT Transplant Coordinator will attempt to contact you by first phoning your home telephone number. If there is no response, they will attempt paging you via your pager. Even though a donor liver receives special handling and will be stored in a special solution to keep it suitable for transplantation, there is a time limit. It is very important that if your telephone number changes, you should immediately inform the BCT Liver Transplant Coordinator. You may also want to get a telephone answering machine and check it often. If you plan on going out of town, be sure to leave your travel plans and contact numbers with the transplant coordinator. When you do get the call from your Transplant Centre, you will probably feel equal levels of excitement and fear. It will seem as if everything is a blur. This is why it is very important for you to make any plans in advance, whenever possible. Make sure you do not eat or drink anything once you have been called to the hospital. It is important that your stomach be empty in order to have surgery. If you are waiting at home, the call to come into hospital for transplant may come at any time of the day or night. The Transplant Coordinator will identify themselves and ask you a few questions. They will ask: How you are feeling If you have any colds or fever If you have a sore throat or diarrhea If you have had any recent infections If you are taking any antibiotics If they have no concerns regarding your present condition they will ask you to come to the hospital as soon as possible. If you live in the Lower Mainland/Vancouver area, it is expected that will arrive at the hospital within 2 hours of the telephone call. If you are coming by car, please ensure that you have someone drive you. If you are coming from outside of the lower Mainland, the Transplant Coordinator will give you detailed instructions regarding the transportation plan. You will either come by air ambulance, commercial flight, or charter flight. The Transplant Coordinator will make the travel arrangements. If you are coming by commercial flight or charter flight, you will need money for a taxi from the airport to Vancouver General Hospital (around $20.00). BC Transplant will cover the cost of commercial flight or charter flight. If you come by air ambulance, you can be billed up to $240.00 depending on where you live. Chapter 4 – Clinical Guidelines for Liver Transplantation – July, 2010 Page 62 See Page 1 for disclaimer
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