Referring Physicians - Liver Transplantation

Primary Care Physicians or Referring Gastroenterologist's may make a referral to the Penn State Liver Transplant program by calling the Liver Transplant office at 717-531-6092 or toll free at 1-800-525-5395. The following information is necessary to schedule the initial evaluation:

 

  • Patient Name
  • Patient Address, Phone Number
  • Diagnosis
  • Date of Birth
  • Social Security Number
  • Insurance Coverage
  • The liver Transplant secretary will call the patient to schedule an appointment.

Prior to Appointment Date
Patients insurance will be verified by our financial counselor to ensure there is a benefit with the insurance provider for Liver Transplant. The Primary Care Physician or Referring Physician will obtain the necessary authorization for patients with "HMO" insurance.

Appointment Date
Liver Transplant Clinic takes place every Monday except for Holidays. Patients will be scheduled for an Abdominal Ultrasound, Abdominal CAT Scan and laboratory work the day of the appointment. The clinic appointment consists of meeting the Transplant Hepatologist, Transplant Surgeon, Transplant Coordinator, Social Worker, Nutritionist and Financial Counselor. Patients should plan on spending an entire day at the Hospital. Testing usually begins at 8:00 am and the evaluation is complete by 5:00 pm.

Testing Prior to the Transplant Appointment
A letter outlining the evaluation will be sent to the patient, Primary Care Physician and Referring Physician. Additional testing is outlined for completion of the Transplant Evaluation. Additional testing is scheduled by the local Physicians and includes the following:

 

  • Pulmonary Function Test (Spirometry)
  • < 50 year old: 2D Echocardiogram
  • > 50 year old or Diabetic: Dobutamine Stress Echo
  • EKG
  • 24-hour urine collection for creatinine clearance
  • EGD- upper endoscopy
  • Portable chest x-ray
  • > 50 year old: Colonoscopy
  • < 50 year old: Flexible Sigmoidoscopy

Listing for Liver Transplantation will not take place until all the required testing is completed, therefore it is very helpful to have all additional testing completed prior to the initial transplant evaluation. Pertinent medical information from the Primary Care Physician and Referring Physician should be faxed to the Liver Transplant office

Listing for Liver Transplantation
After the required testing is completed the patient’s case is presented to The Liver Transplant Selection Committee for determination of listing. A letter of determination is sent to the patient, Primary Care Physician and Referring Physician. If additional testing is required to complete the evaluation the patient and Primary Care Physician will be notified. Patients that are determined suitable candidates for listing are placed on the United Network for Organ Sharing (UNOS) wait list. Listed patients will be followed in the Liver Transplant Clinic for management of liver disease, every 3 - 6 months. Coordination of care and management of liver disease is a shared responsibility of the Transplant Center, Primary Care Physician and Referring Gastroenterologist.

Degree of Medical Urgency
Patient’s listed for Liver Transplant are assigned a MELD Score (Model for End-stage Liver Disease), which is a continuous disease severity scale, highly predictive of mortality risk from liver disease.  The MELD Score incorporates Bilirubin, INR and Creatinine in an equation.  Its ability to predict death is NOT improved by including subjective parameters like variceal bleeding, ascites and encephalopathy.

The MELD Scoring system has been determined to better discriminate between patients at risk of dying of liver disease based on their disease severity.  MELD uses objective criteria to determine the severity of illness and significantly reduces the influence of waiting time on selected patients.

MELD scores range fro 6 to 40, with 40 being the highest priority for Liver Transplant with the exception of Status 1 patients.  The MELD score is calculated from the most recent laboratory values.  Lab values must be updated according to the Recertification Schedule below, otherwise patients will automatically revert to the previous lower MELD score.

RECERTIFICATION SCHEDULE
ScoreRectificationLab Values
> 25Every 7 days< 48 hours old
24-19Every 30 days< 7 days old
18-11Every 90 days< 14 days old
< 10Every year< 30 days old

Status 1: patients with Fulminant Hepatic Failure, Primary non-function or Hepatic Artery Thrombosis of a transplanted liver within 7 days of implantation, or Acute decompensated Wilson's disease are considered highest priority for Transplant regardless of the MELD score.