The intestinal and multivisceral transplant team consists of many members to make sure your receive the best care possible. The team may include a:

• Transplant Surgeon

• Gastroenterologist

• Hepatologist (Liver Doctor)

• Registered Dietician

• Infectious Disease Specialist

• Cardiologist (Heart Doctor)

• Transplant Nurse Coordinator

• Mid-level Clinicians (Physician Assistant, Nurse Practitioner)

• Transplant Pharmacist

• Physical Therapist

• Occupational Therapist

• Speech-Language Pathologist

• Pathologist

• Psychologist or Psychiatrist

• Social Worker

• Financial Coordinator

The evaluation for transplant consists of many outpatient appointments, including consultations, lab tests, and imaging studies.

These tests and meetings help to determine if:

• Transplant is the right treatment;

• There are alternative treatments that may help;

• You are well enough to have a transplant.

Depending on the transplant center that you chose will determine how these appointments will be scheduled and conducted. Many centers will try to schedule the entire evaluation in a one to two-week period to accomplish everything in a short period of time, especially if you are coming in from out of town. It is important to discuss the arrangement with your individual transplant center.

Transplant Nurse Coordinators

• Provide education regarding the transplant evaluation process and care pre/post-transplant.

• Allows time to ask any questions you may have and become fully informed.

Intestinal Transplant Physicians/ Gastroenterologists

• Assist in medical evaluation and treatment of underlying intestinal disease.

• Assess ability to respond to medical and dietary intervention.

Intestinal Transplant Dieticians

• Assess the ability to respond to dietary intervention.

• Manage nutrition pre/post-transplant.

• Educate on nutrition therapy and transition to a full oral diet.

Intestinal Transplant Surgeons

• Discuss appropriateness of transplant based on the evaluation.

• Educate you about the types of transplant, benefits, risks, and possible complications.

Anesthesiologists

• Determine how to provide safe administration of general anesthesia during transplant.

Social Workers

• Assess your support system, adherence history, and motivation for intestinal transplant.

• Provide support resources, such as assistance with finding lodging near the transplant center if you are coming in from out-of-town.

Financial Counselors

• Discuss transplant coverage, costs associated with transplant, and medication costs.

Psychiatrists

• Conducts in-depth psychiatric evaluation and assessment.

Pharmacists

• Reviews medications to determine if there are any contraindications to transplant.

• Addresses any concerns related to current and potential post-transplant medications.

Dentists

• Assess oral health.

Gynecologists (females)

• Assess reproductive health.

Infectious Disease Physicians

• Assess past and current infections.

• Assess past history on where you have lived to help determine exposure to particular bacteria and fungi.

• Determine need for vaccinations.

• They provide education on preventing infections and guidance on travel safety precautions.

Blood Tests

• Determines how serious organ disease is and which organs are diseased.

• Determines blood type.

• Determines immunity or presence of certain viruses.

Chest X-Ray

• Assesses the lungs.

Urine Test

• Screens for urinary tract disease.

• Tests for alcohol and drugs.

EKG

• Assesses the electrical activity of your heart.

Echocardiogram

• Assesses the structure of your heart.

Stress Test

• Assesses the cardiovascular capacity of your heart.

Cardiac Catheterization

• Diagnose and treat problems with your heart.

CT Scan and/or MRI

• Assesses your organs extent of disease.

• Checks for any tumors.

• Checks the blood supply to and from the diseased organ.

Biopsy

• Helps to determine the cause of disease.

• Assesses your organs extent of disease.

Ultrasound

• Determines size and shape of organ.

• Checks for tumors.

Pulmonary Function Test

• Assesses function of the lungs.

Endoscopy

• May include colonoscopy, esophagogastroduodenoscopy (EGD), endoscopic retrograde cholangiopancreatography (ERCP), bronchoscopy, or small bowel capsule endoscopy.

• Assesses the inside of organs.

• Possible source of biopsies.

Venous Mapping

• Assesses vascular access in the body.

Pap Smear (females)

• Screens for cervical cancer.

Mammogram

• Screens for breast cancer.

DEXA Scan

• Assesses bone health.

Informed consent begins at the start of the transplant evaluation process and continues until transplant. Informed consent ensures that you fully understand the entire transplant process, both pre- and post-transplant. It also provides you with full knowledge of the possible risks and benefits associated with transplant and gives you the right to make educated health decisions.

Questions to Ask Your Transplant Team to Help Make an Informed Decision:

• What are my choices other than transplant?

• What are the risks and benefits of transplant?

• What does the evaluation process include?

• How long do most patients with my blood and organ type wait at this hospital for this type of transplant?

• How long has this hospital and these surgeons been doing this type of transplant?

• How many of these types of transplants does this hospital or surgeons perform each year?

• Am I allowed to be listed at more than one transplant center (e.g. multi-listing)?

• What are the organ and patient survival rates for my type of transplant at this hospital and how does that compare with the survival rates of the rest of the country?

• How does the medical team decide whether or not to accept an organ for me?

• How long will I have to stay in the hospital and the area after my transplant?

• What is the extent of appointments and tests that I will have to endure after my transplant?

• What are the costs should I expect associated with transplant and what financial assistance is offered?

For more information on comparing transplant centers, visit the Scientific Registry of Transplant Recipients (SRTR) site for the most up-to-date data.

Following completion of the evaluation for intestine transplantation, the patient’s information is presented to the multidisciplinary selection committee. Recommendations for transplant are made by the committee after review and discussion of test results and consultations:

• Intestinal transplant may be recommended, and the patient will be formally listed with UNOS.

• Transplant may be deferred and the patient will not be listed because additional information or tests are needed, medical management strategies may be indicated, or current psychosocial concerns are significant and must be resolved before listing.

• In some cases, transplant may be denied due to medical issues that may affect survival or the patient will benefit from medical or other surgical interventions rather than transplant.

The members of the committee will vary by center and patient diagnosis, examples of members includes:

• Transplant surgeons

• Gastroenterologists

• Nutritionists

• Social workers

• Ethicists

• Psychiatrists

• Mid-level providers

• Advanced practice nurses

• General surgery

• Pharmacists

• Anesthesia

Note: For most transplant centers and states, your transplant team will officially list you with UNOS, the national organ waiting list. If you are pursuing an intestinal or multivisceral transplant in any state other than Ohio please proceed to the section on “Waiting List” to continue reading; however, if you are pursuing a transplant in Ohio, then read the portion of information below.

• If you are accepted as a candidate for transplant at your transplant center in Ohio, your information will be sent to the Ohio Solid Organ Transplant Consortium (OSOTC) for further review.

• This process requires the transplant physician to write a letter to OSOTC, which may take 2-4 weeks.

• The primary purpose of the Ohio Solid Organ Transplantation Consortium is to ensure equitable access to quality medical care for those most likely to benefit from transplantation, regardless of ability to pay.

• Once OSOTC has granted approval and your insurance company has approved you, information is then submitted to United Network for Organ Sharing (UNOS) for listing on the national waiting list.