Frequently Asked Questions
The transplant process can leave you with a lot of questions. Whether you are an organ recipient, living donor for liver transplant or trying to figure out insurance policies, we've compiled a list of questions to help you understand the entire process and the finances associated with it. Please contact us if you have any additional questions.
What is a liver transplant?
One of the most important organs in the body, the liver is essential to good health. When the liver can no longer perform its normal vital functions and there is no other way to correct the problem, a transplant may be recommended. A liver transplant involves surgery to replace the patient's liver with a new liver or part of a new liver, followed by life-long medication and clinic follow-up visits to prevent rejection of the new organ.
Deceased donor transplant - As long as there is a heartbeat, the organs of a healthy person in a traumatic event causing death are good candidates for donation. With consent from the donor's next of kin, artificial support keeps the organs functioning until donation occurs.
Which patients are eligible for liver transplant?
Patients with acute liver failure may be candidates, as well as those with chronic liver failure due to diseases such as hepatitis B & C, metabolic diseases, some liver cancers and biliary cirrhosis. There are other conditions that result in the need for transplantation, but regardless of the cause, the need for transplantation is determined by the occurrence of liver failure.
Which patients are NOT eligible for liver transplant?
Patients with the following conditions may not be eligible for liver transplant:
Liver cancer that is too extensive or has spread from the liver to other parts of the body
Some types of cancer other than liver
Recent heart attack, angina at rest or advanced heart disease
Untreated or uncontrolled major psychiatric illness
Non-rehabilitated substance abuse
Major infections such as AIDS or current TB
Age of 70 or greater
How are potential transplant patients evaluated?
With a referral from their primary physician, potential candidates are given a pre-transplant evaluation. This includes:
personal interview with the patient
visits with a social worker and financial counselor
complete medical work up including lab tests, abdominal ultrasound and/or CT scan, psychological clearance, colonoscopy, EKG and a number of other tests
The transplant team will review the evaluation results, and if they find that the patient would be a good candidate for a liver transplant, and financial arrangements are in order, the patient is officially listed on the recipient waiting list with the United Network for Organ Sharing (UNOS).
The evaluation can take four to six hours or longer. Some patients may prefer to spend the night near the hospital if they live out of town. An excellent option for an overnight stay in a compassionate environment is Nora's Home, which offers a home away from home at a nominal fee for transplant patients and their families. Call 1-877-390-4663 for reservations.
The evaluation process also involves scheduling of tests and other physician referrals, so it may take several weeks to complete the evaluation and place a patient on the transplant waiting list.
What happens after a patient is placed on the waiting list?
Patients listed for a liver transplant are tested at intervals and assigned a Model for End-Stage Liver Disease score, which is based on a system regulated by UNOS. The MELD score uses several measures to provide an indicator of a liver patient's health. Patients with higher scores are given priority for transplants. Patients who have sudden onset, rapidly worsening liver disease and are currently in intensive care with a life expectancy of less than seven days are given priority, as well.
Generally, transplant outcomes improve when patients are in the best possible shape. We encourage patients to use the waiting period as a time to lose weight, if necessary, to enrich personal relationships, to find and use ways to reduce stress and to improve diet and exercise habits. For patients who are currently smokers, they should quit as soon as possible.
Keeping in Touch
If a patient is listed on the recipient waiting list, the transplant team needs to be able to reach them quickly. If there is any change of telephone number, address, insurance or medical condition, the transplant coordinator must be informed right away.
What part of the transplant cost is covered by my insurance? How does this apply to my deductible?
Coverage varies depending on the patient and the company. Most commercial plans cover solid organ transplants to a certain degree. To find out what your company covers, contact them directly. Our financial coordinators are available to help you find the information you need.
What is the cap on my commercial insurance coverage? What happens if my financial coverage runs out?
Because most commercial plans have a lifetime maximum $1,000,000 and up, it is unusual to exceed that amount. If it happens, there are other options available. Our financial coordinators will help you find the one for you.
Are expenses for food, housing and transportation covered while I wait for my transplant?
These costs are rarely covered. Plan ahead for costs associated with these services. Again, our financial coordinators are available to help you find possible assistance.
How much coverage will I receive for post-transplant medications? What is the co-pay amount?
This depends upon your insurance coverage. Most plans have predetermined benefits for the pharmacy network it covers. Ask our financial coordinators for help understanding coverage needs.
What financial coverage is accepted by the hospital (such as Medicare, Medicaid, private insurance)?
Although your insurance company allows you to come to our facility for certain hospital services, you might not be covered for transplantation here. Often, the referring physician determines the location. Our financial coordinators will verify the location to make sure patients don't incur unnecessary financial burdens.
How much will the transplant cost? How much will I have to pay?
Although transplants are expensive, don't get discouraged. Your insurance company will pay a large part of your transplant costs. Your out-of-pocket costs depend upon your coverage (there is usually a maximum annual out-of-pocket cost). Our financial coordinators are here to help you put it into perspective, and payment plans are available to help pay remaining costs.
Other transplant-related expenses to consider:
Loss of income due to leave of absence from work
Child care (if appropriate)
Transportation to and from the hospital
Parking expenses for visits to the Transplant Institute (if applicable
Accommodation expenses or temporary housing expenses associated with being accessible to the Transplant Institute (for you and family members)
Long-distance telephone expenses if relocation is necessary (to be more accessible to the Transplant Institute)
Food expenses for family support person
Post-transplant medication costs
Post-transplant follow-up tests and appointments