Liver Transplant Program
Liver Transplant Program
Massachusetts General Hospital, Warren 735
55 Fruit Street
Boston, MA 02114
Cooley Dickinson Hospital
30 Locust St. (Route 9)
Northampton, MA 01060
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Explore This Treatment
About the Program
A pioneer in organ transplant since 1963, the Massachusetts General Hospital Transplant Center draws from state-of-the-art technology and leading-edge medical and surgical interventions to provide individualized, ongoing care for adult and pediatric patients with liver disease. Since 1988, Mass General has performed more than 1,000 liver transplants, making us one of the largest transplant centers in New England. Our Liver Transplant Program provides complete treatment, transplant and management options for patients with acute or chronic liver disease, as well as patients with liver cancer.
Advanced Evaluation, Multidisciplinary Care
Our patients receive integrated, comprehensive care, beginning with a careful assessment and discussion to ensure that transplantation is the patient’s best treatment option. Candidates work with a transplant coordinator, who participates in the initial evaluation, gathers medical information and previous test results, and manages the patient’s full evaluation, which includes:
- Patient education
- Surgical and psychosocial evaluation
- Transplant-specific testing
To begin the liver transplant process, you or your physician should contact the Mass General Liver Transplant Clinic. You will be asked to provide your medical records. A liver transplant nurse coordinator and a transplant hepatologist will review your referral and medical records once they have been received. Transplant Center staff will then schedule an initial evaluation appointment.
Depending on the number of tests required for each patient, the length of the evaluation process can vary. Our goal is to complete all testing within one month, except for patients in need of emergent transplantation, which are completed within days, while in the hospital.
Part One: Initial Evaluation
You will begin the liver transplant evaluation at the Mass General Multidisciplinary Liver Transplant Evaluation Clinic, held on Mondays and Wednesdays. During the day you will:
- Attend a liver transplant education session
- Have blood testing done
- Meet with all the members of the transplant team, including your individual nurse coordinator, hepatologist, surgeon, social worker, dietitian and financial coordinator
Part Two: Specialized Testing
After the initial clinic visit you will return for additional testing and appointments as needed. The liver transplant team will assist you in scheduling these tests and appointments, which may include:
- Cardiac stress testing
- Chest X-ray and electrocardiogram (EKG)
- Additional blood and urine tests
- CT scan
- Meeting with a pharmacist
- Meeting with a psychiatrist
- Meeting with the liver cancer team
You will be responsible for scheduling the following tests with your local doctor and/or providing recent results in order to complete the transplant evaluation:
- Colonoscopy (age 50+)
- Dental exam (within the past year)
- Pap smear
- Mammogram (age 40+)
Part Three: Review by Committee
Once testing is complete, the entire transplant team will meet to determine your candidacy for listing for liver transplantation. You and your referring physician will be informed of the committee’s decision within approximately one month.
Liver transplant candidates are placed on the national United Network for Organ Sharing (UNOS) waiting list, which manages the distribution of organs nationwide.
If you are found to be a good candidate for liver transplantation, you will be placed on a waiting list managed by the UNOS. UNOS is contracted by the federal government to manage the nation's organ transplant system.
Because there are many more people who need a liver transplant than there are deceased donor livers available, UNOS will rank you based on how sick you are, as measured by your Model for End-Stage Liver Disease (MELD) score. Certain patients are eligible for additional MELD points (called “exception points”) from UNOS, based on their disease. For example, patients with hepatocellular carcinoma (liver cancer) or hepatopulmonary syndrome (a lung condition caused by liver disease) may be eligible for additional MELD points.
Because there are so few livers available compared with the number of patients in need of transplantation, many patients are very ill by the time they reach the top of the waiting list. However, there is a spectrum of donor livers, some of which may not be taken by patients at the top of the list, but which might be appropriate for patients further down the list. Living donor liver transplantation is another option to expedite transplantation. For more information, please contact your transplant coordinator to make an appointment to discuss these options.
When a deceased donor organ is available, you will receive a call from your coordinator or surgeon asking you to come into the hospital for the transplant. Since this call can come at any time during the day or night, any day of the week, it is important for the transplant team to be able to reach you. You should provide our center with all of your phone numbers, as well as the phone numbers of a few emergency contacts, so that we can contact you when needed.
Collaboration with Liver and Cancer Centers
Specialists at the Mass General Transplant Center work closely with their colleagues in the Mass General Liver Center and Mass General Cancer Center. This collaboration allows patients with liver disease and cancer to receive coordinated care that includes the most advanced diagnostic and treatment options. Many patients with liver cancer are eligible for liver transplantation. Our surgeons have extensive experience in both complex and minimally invasive removal of liver tumors.
Living Donor Program
Mass General has one of the most active and experienced living donor liver transplant programs in New England. Through living donor liver transplantation, a family member or friend donates a portion of his/her liver, allowing patients to receive a transplant without a prolonged waiting period. The donor’s healthy liver grows back to full size within a few weeks.
Donating a portion of your liver to another individual is a great act of kindness and can be life saving for the recipient. A liver transplant is a complex surgery for both the donor and the recipient. In order to effectively plan for the surgery and ensure the best possible outcomes, the Mass General Liver Transplant Team evaluates living donors in a three-part process. Potential donors may choose to discontinue their evaluation at any point in the process, for any reason, with complete confidentiality. Typically, the Transplant Center and the recipient's insurance will cover the cost of the evaluation and surgery.
Phase One: Questionnaire and Blood Tests
- Donors must be between the ages of 18 and 55, and have no serious medical problems
- The donor evaluation begins with the potential donor contacting our transplant center and answering a few questions that allow us to determine the donor’s overall health status
- Standard blood tests will be done to determine blood type, liver function and overall health status. Blood testing can be performed at Mass General or at another local hospital
Phase Two: Team Evaluation and Surgeon Visit
- The donor will meet with our hepatologist, living donor nurse coordinator, financial coordinator, social worker, living donor advocate and nutritionist to learn about the donation process and to ask any questions
- The evaluation includes a complete medial history and physical examination, and additional testing such as an electrocardiogram (EKG), chest X-ray, a CT scan of the abdomen to evaluate liver anatomy and other blood work or tests as needed
- Next, the donor will meet with a surgeon from the Mass General Liver Transplant Program to discuss the surgical procedure and hospital stay. The operation is performed using a laparoscopic-assisted technique, and the majority of donors go home five to seven days after surgery
Phase Three: Anesthesia Evaluation and Scheduling Surgery
- Once all tests are complete, the transplant team will discuss the donor's eligibility at our weekly multidisciplinary liver transplant meeting to determine if the donor is approved for surgery. Once approved, we will schedule the surgery on a date that is convenient for both the donor and recipient
- The donor will meet with his/her surgeon to sign the surgical consent form and to answer any last-minute questions. The donor will also meet with an anesthesiologist to discuss the anesthesia process and answer any additional questions
In spite of advances over the last 50 years in anti-rejection medications, the side effects of long-term immunosuppressive therapy remain a major problem for post-transplant patients. The MGH Transplant Center is participating in trials which allow transplant patients to take fewer or no medications.
Hepatitis C Treatment
Hepatitis C infection can return after liver transplantation, occasionally causing liver damage severe enough to require re-transplantation. The MGH Transplant Center offers the latest FDA-approved anti-viral therapies and participates in clinical trials utilizing promising new agents.
For more information about hepatitis C clinical trials, call 617-724-3836.
Hepatitis C Positive Liver Transplant for Hepatitis C Negative Recipients
Currently there are more available hepatitis C positive deceased donors in New England than there are recipients. With the arrival of new anti-viral agents Hepatitis C cure rates are almost at 100%. Under a clinical trial protocol we will be transplanting livers from donors who are positive for hepatitis C virus into select recipients who are not infected with the hepatitis C virus. Patients who enter into this trial receive immediate pre-emptive treatment for hepatitis C. This will allow these selected recipients to be receive a transplant more quickly, avoiding many consequences of prolonged time on the waitlist.
Liver Perfusion Device
Innovative studies are underway to improve the preservation and function of organs from deceased donors. Perfusion devices may help solve the organ shortage by uncovering alternative sources for organs. The MGH Transplant Center is a leading site in the field of organ perfusion and preservation.
HOPE Act: HIV+ Donors for HIV+ Recipients
Until 2015, transplanting organs from HIV positive donors was not allowed under the National Organ Transplant Act of 1984. However, since HIV treatments have improved and HIV positive transplant recipients have done well after transplant, the HIV Organ Policy Equity (HOPE) Act was recently passed. The HOPE Act allows organs from HIV positive donors to be transplanted into HIV positive recipients. These are organs that would have been discarded before the HOPE Act was passed. The MGH Transplant Center is one of the few hospitals in the United States doing these transplants.
The Mass General Liver Transplant team guides patients through every stage of care with a multidisciplinary team of doctors, nurses, case managers, financial coordinators and other clinicians to help navigate the transplant process.