The process of liver transplantation may seem confusing or sometimes overwhelming. We understand, and our team is here to answer your questions. We encourage families to have in-depth conversations with us during visits and to call at any time with further questions.

Some of the most common questions we receive are answered below. For more information, or to find out how this information applies to your child, please reach out to our liver care experts.

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Frequently Asked Questions

What is a liver transplant?

During a liver transplant, a child’s diseased liver is removed and a healthy liver from a donor is put in. Liver grafts can be donated by either living or deceased donors. Partial liver grafts may come from a person who has donated a part of their liver (living donor graft), or from a deceased donor (reduced-size grafts and split liver grafts). These partial grafts are known as ‘technical variant grafts’.

When might a child require a liver transplant?

A child’s liver may stop working due to infection, disease, injury or medication overdose. In other cases, a child’s liver may become slowly scarred and damaged due to disease or illness, unable to function sufficiently. In time, the liver fails. The most common causes of liver failure in children include:

• Acute liver failure caused by injury, infection, autoimmune diseases or medication overdose
• Biliary atresia and other disorders of the bile ducts, such as primary sclerosing cholangitis
• Cirrhosis caused by chronic viral or autoimmune hepatitis
• Genetic and metabolic disorders such as alpha-1 antitrypsin deficiency, Wilson disease, or glycogen storage diseases
• Liver tumors

There are other conditions, such as Budd-Chiari syndrome or Abernethy syndrome, that may lead to liver failure and the need for a liver transplant. No matter your child’s condition, his or her liver health and overall health will be carefully evaluated before making the decision to undergo a liver transplant.

How long will my child have to wait for a liver transplant?

The waiting time for your child to get a liver will depend on several factors:

• Living Donation: If a living donor is available, the transplant will be scheduled, and your child will not need to rely on the allocation of a deceased donor liver.
• Deceased Donation: For children awaiting an offer from the deceased donor pool, their waiting will depend on their disease severity. It is difficult to predict the length of time a candidate will wait for an acceptable offer from the deceased donor pool. In all cases, our goal is to match your child with the best possible liver transplant opportunity for them.

Liver donors from the deceased donor waiting list are allocated according to several factors, including your child’s disease severity, the donor hospital’s proximity to the candidate’s center, and other factors such as donor size and age. At Nationwide Children’s, we work very hard to optimize your child’s health during the waiting time, and to shorten the waiting time as much as possible.

What determines when my child gets a liver?

The United Network for Organ Sharing (UNOS) manages all organ allocations from deceased donors. Nationwide Children’s Hospital is a member of the OPTN network and participates in the organ allocation process directed by UNOS. We will regularly assess your child’s health to make sure that UNOS has the latest information on your child’s health status. UNOS manages the computer-driven organ matching algorithm that determines the allocation order for every liver that becomes available. The allocation order is determined by the match-run list generated by UNOS. Your child’s position on the match run list is driven by several factors, including their disease severity, the donor hospital’s geographical proximity to Nationwide, and other factors such as donor size and weight. Generally, liver offers are allocated to the sickest patients first. Your child’s score can change over time, which means it is crucial to have your child regularly assessed by the transplant team during the waiting period. UNOS offers a lot of information on how the process works and the information utilized for organ allocation. That information can be found on the UNOS website.

What should we consider when choosing a hospital for a liver transplant?

First and foremost, you should choose a hospital with providers that have a large experience in performing liver transplants, with a UNOS-certified pediatric liver transplant program. The surgeons and doctors at the hospital should be board-certified, pediatric experts in liver care and surgery. If your child needs a special type of transplant — such as a living donor transplant or a reduced-size graft or split liver graft — a transplant center that has surgeons experienced in these procedures is important. In addition, your family will spend a lot of time with the entire care team before and after the transplant. The program should offer comprehensive testing and support, and a team of specialists who work together to come up with a care plan for your child. The care team should work with you to make sure you understand the plan and your child’s health care needs. Consider how the program will make your family comfortable and whether their liver care team can offer all the medical, social, financial, nutritional and psychological support your child needs before, during and after the transplant. Nationwide Children’s Liver Care program offers all of these features and more. With some of the most experienced pediatric liver transplant surgeons in the country, we can offer the full range of transplant options. We also offer a full team of specialists who pay attention to your child as an individual and craft a personalized care plan to help your family meet your goals for liver care.

What are living donor and split liver transplants?

Depending on your child’s liver problem and health status, different transplant options are available. In young children, reduced-size liver grafts and split liver grafts offer more options for children who require a transplant. More options can mean a shorter waiting time. In split liver transplantation, a deceased donor can have their liver divided into two portions that can be transplanted into two recipients. In this way, the donor’s liver can save two lives. Another option your child may have is to receive part of a liver from a living donor, such as a family member or family friend. In this case, a portion of the liver is removed from the living donor and transplanted into your child. The liver’s amazing capacity for regeneration ensures that each segment will regrow to a normal size for both the donor and the recipient. In either case, your child and the donor must be a “match” based on the care team’s evaluation of the donor’s blood type, liver size, general health and the anatomy of the donor’s liver. Our surgeons are experienced in all variations of liver transplants and are experts in evaluating donated livers to make sure the organ is able to be safely used for transplantation. Talk to your child’s liver team about options that may be right for your child and whether these options may reduce your child’s waiting time for a transplant.

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