Getting the Go-Ahead
When a liver from a deceased donor is available, Lifecenter Northwest, the organ procurement organization in the Pacific Northwest region, will call the transplant team.
Both a nurse coordinator and a transplant surgeon are on call 24 hours a day at Seattle Children's Hospital. The coordinator will call the transplant surgeon to 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.
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 ONE HOUR.
We will make every effort to contact you. We will first call your home phone number. Then we will page you. You must answer all pages that you receive, even if you do not recognize the number.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
If we are unable to contact you within one 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.
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.
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 Pediatric Intensive Care Unit (PICU) 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 PICU and near 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 a regular IV.
The surgeon will remove the diseased liver and prepare the donor liver for transplant. To re-establish the proper circulation to the transplant liver, the surgeon will connect the hepatic veins (or inferior vena cava), the portal vein and the hepatic artery of the donor liver to the same vessels in your child.
Finally, the surgeon will connect the bile duct to restore the normal flow and drainage of bile from the transplant liver. The donor bile duct will be connected directly to your child's bile duct, unless that is not possible, as in biliary atresia. In this case, the bile duct will be connected directly to a segment of intestine.
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 PICU.
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:
These monitors are used to check heart rate, respiratory rate, blood pressure and oxygen in 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.
The catheter is used to drain urine from the bladder. It measures urine output and checks liver function.
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.