Getting the Go-Ahead

Deceased-donor liver transplants

When a liver from a deceased donor is available, LifeCenter Northwest, the organ procurement organization in the Pacific Northwest region, contacts Seattle Children's Hospital.

Both a nurse coordinator and a transplant surgeon are on call 24 hours a day at Seattle Children's Hospital. The coordinator and the transplant surgeon will discuss the history and condition of the donor to determine if this donor organ would be a good match for your child.

If the organ is a good match, the transplant nurse coordinator will contact you to see if your child is able to undergo the transplantation operation. The coordinator must make sure that your child does not have any new health problems that require delaying transplantation, such as a cold or the flu.

Current United Network for Organ Sharing (UNOS) policy requires that the transplant center (Seattle Children's transplant team) decide whether to accept or turn down the liver offer within 1 HOUR.

If we are unable to contact you within 1 hour, you will miss a very important opportunity for a transplant. The liver will be offered to the next person on the transplant list, and your child will remain on the waiting list.

We will make every effort to contact you. First, we will call the phone number you gave us as your primary contact. Then, we will call any other numbers we have to make contact. If you do not have a cell phone, ask the coordinator to order a pager for you. You might not recognize the phone number on the pager or your cell phone. The number may be the coordinator’s home or cell phone number.

We must also have a list of your contacts (e.g., family, friends, work, school, etc.) to call. We may call the local police to help find you.

When we contact you, the coordinator will discuss:

  • If your child is well enough for surgery
  • How you will get to the hospital
  • How long it will take you to arrive
  • When to have your child stop eating and drinking to prepare for surgery
  • Where to park and check in at the hospital when you arrive

Living-donor liver transplants

If you and the transplant team have decided on a living-donor transplant and a donor has volunteered and been approved, Seattle Children’s and University of Washington Medical Center (UWMC) will coordinate your child’s surgery and the surgery of the person donating their liver. The surgeries will happen the same day at about the same time.

Preparing for Surgery

At the hospital, we will perform blood tests and a chest X-ray to make sure your child's condition is stable enough for surgery.

We will start an intravenous (IV) line to give your child medicines and fluids. An IV is a small needle inserted into your child's arm so that we can easily inject medicines and fluids directly into a vein.

If your child is receiving a liver from a deceased donor, the time of surgery is planned to match the liver's arrival at Seattle Children's. The liver cannot live long outside a body, so it must be removed from the donor, transported to Seattle Children's and then transplanted into your child within a few hours.

If your child is receiving liver tissue from a living donor, the teams at Seattle Children’s and UWMC (where the donor has surgery) will stay in contact during the surgeries. They will coordinate to make sure the tissue is transplanted as soon as possible after it is removed from the donor.

You may stay with your child until the anesthesiologist has put your child to sleep. We will then take your child to the operating room. At this time, you can check in at the Neonatal Intensive Care Unit (NICU) front desk. There, you will be given a pager, so that operating room staff can updated you about how your child is doing during the surgery.

There are many places for you to wait at the hospital during your child’s surgery, including the hospital cafeteria, the chapel, the Family Resource Center and family waiting rooms in the Forest Building by the Pediatric Intensive Care Unit (PICU) and another waiting area near the NICU desk, which is close to the operating room.

Liver Transplantation Surgery

Once your child is asleep under anesthesia, the transplant team will insert additional IV lines, including an arterial line to monitor blood pressure and take blood samples.

The team will also insert a central venous catheter into a large vein, to deliver larger amounts of medicines and fluids than is possible with a regular IV.

The surgeon will remove the diseased liver and prepare the donor liver for transplant. There are several transplant options, including:

  • Deceased-donor liver transplant
  • Living-donor liver transplants
  • Split-liver transplants
  • Reduced-size liver transplants

Your child’s team can explain the type of surgery your child will have.

To get blood flow to and from to the transplant liver, the surgeon will connect the veins and arteries of the liver to your child’s blood vessels.

 

Finally, the surgeon will connect the bile duct to allow drainage of bile from the transplant liver.

The operating room staff will let you know how your child is doing during the surgery. They will contact you through the pager you picked up from the NICU.

After the Surgery

After surgery, your child will go to the PICU. You will be able to be with your child there.

Here are some of the things you may see attached to your child in the PICU:

Monitors

These monitors are used to check heart rate, respiratory rate, blood pressure and oxygen in your child's blood.

An endotracheal (ET) tube

This tube was placed in your child's windpipe during the surgery and connected to a ventilator to help with breathing. The doctors will remove the ET tube when your child no longer needs help breathing.

A nasogastric (NG) tube

This tube passes through the nose and into the stomach, to help to drain secretions from the stomach.

Several abdominal drains

These drains are placed in your child's stomach area to help remove extra fluid drainage from the surgical site.

A urinary catheter

The catheter is used to drain urine from the bladder. It measures urine output.

Several IV lines

These lines will be used for pain medications, antibiotics and other fluids that your child will need.

An arterial line

This line is used to check blood pressure and provide blood samples. The arterial line looks like an IV, but it's in an artery rather than a vein. It will be removed before your child leaves the PICU for the Surgical Unit.

A central venous catheter

This catheter is placed in a large vein to give IV fluids and provide blood samples. If your child needs to go home with the catheter still in place, the nurses will teach you how to care for it.

Some of these tubes and lines will be removed when your child leaves the PICU. Others may stay in longer.