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

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Guidebook for the Solid Organ Transplant Programme Chapter 4 4.1.4 ACTIVATION CONT. All preoperative investigations become a permanent part of the BCT Chart. A letter outlining the assessment and plan for follow up is written by the transplant hepatologist and the surgeon and sent to the referring specialist with copies to the family doctor and to the BCT chart after each visit to the BCT clinic. Nursing Assessment is charted on the progress notes of the BCT chart. When a patient is ready for activation a Recipient Activation form is filled out (See Appendix N) and remains in the BCT chart. A letter is sent to the referring specialist, with copies to the family doctor and the patient informing them of the activation. When patient is placed on Active Liver Transplant list, the Clinical Coordinator reviews the updated active list to ensure accuracy. Critical recipient-specific listing items are documented in the BCT patient chart as well as on the Active Liver List. The Active List is updated as necessary to change status, weight, etc. The Active Liver List is discussed and reviewed at the weekly Liver Team rounds. Any changes to the Active List shall be made under the direction of the transplant physician and/or surgeon on call. A copy of the Active Liver List is kept in Recipient Coordinator’s On-Call Binder. Each member of the Liver Transplant team receives an updated list at weekly Liver Team meetings. An updated list shall be distributed to the on call transplant physician, transplant surgeon and Clinical Coordinator as changes occur. In addition to other information, patient's home address, phone number, contact number, referring specialist and family doctor are found on the “Extra-Renal Transplant Waiting List Demographic” form, which is located in the Clinical Coordinators on call book. (See Appendix Q: When a Liver Becomes Available) 4.1.5 PATIENT DEEMED NOT TO BE TRANSPLANT CANDIDATE Patients who are considered unsuitable for transplantation and therefore discharged from BC Transplant's follow-up care are informed of the decision by the Clinical Coordinator and offered the opportunity to meet with the liver transplant team members for a face to face meeting. The Medical and Surgical Director of the Liver Transplant Program writes a letter to the referring physician and the patient’s primary care physician informing them of the decision. Patients in whom a contraindication for transplantation exists or those who are felt not to be candidates for other reasons are returned to their referring physicians for ongoing care. Chapter 4 – Clinical Guidelines for Liver Transplantation – July, 2010 Page 7 See Page 1 for disclaimer
Guidebook for the Solid Organ Transplant Programme Chapter 4 4.2.1 DONOR COORDINATION 4.2 Transplant When a donor liver becomes available, the transplant surgeon on call and hepatologist review the list of activated patients with compatible blood type to the donor and select the recipient based on medical urgency, size compatibility and waiting time on the list. Patients on the waiting list are discussed at the weekly activation rounds. Changes in status are in accordance with the accepted Canadian Society of Transplantation (CST) criteria (i.e., status 1 to 4). Patients who are assigned a higher priority status are given preference for transplantation (if an organ becomes available) compared to patients who have lower CST priority status listing. 4.2.2 RECIPIENT COORDINATION (See Appendix R: VGH Transplant Checklist) 4.2.3 PRE-OPERATIVE PROTOCOL When a suitable donor organ has been identified, the recipient will be admitted to Vancouver General Hospital and assessed by the hepatologist on call. Pre-op blood work and a chest X-ray is done. If no contraindications to transplantation have arisen, the patient is prepared for surgery. (See Appendix B: Pre-Liver Transplant - Adult) 4.2.4 BACK-UP Occasionally a second potential recipient is prepared for transplant in the event the first recipient is found to be unsuitable. Chapter 4 – Clinical Guidelines for Liver Transplantation – July, 2010 Page 8 See Page 1 for disclaimer
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