Cadaveric liver transplant flow chart

							                                            Legislative Council Q7                                                                Annex
                                       Liver Transplantation Flow Chart

                           Patients with liver disease referred to Queen Mary Hospital (QMH) for liver transplant #




           Attend QMH liver clinic                    Attend QMH liver transplant clinic                                Attend QMH paediatric
                    (Medical)                                         (Surgical)                              surgical/medical clinic (Paediatric)


                                                 If indicated                                          If indicated


      Admitted to medical ward for                          Admitted to surgical ward for                         Admitted to relevant pediatric
           liver transplant work-up                             liver transplant work-up                        ward for liver transplant work-up


                                                                     Work-up completed



                             Case submitted to Joint Liver Transplant Meeting for discussion, attendees include:
                                  Liver Transplant Surgical Team
                                  Liver Medical Team
                                  Anaesthetist Team
                                  Pediatric Team (if case available)

                                                      Accepted for transplant                                                 Not accepted for transplant


      Case entered into the liver transplant waiting list in                                 Further evaluation, may represent later; or
       ORTS*                                                                                  Continue follow up in liver transplant clinic; or
      Outcome of the meeting documented on patient’s file                                    Continue follow up in liver clinic; or
       by Liver Transplant Coordinator (a specialist nurse)                                   Discuss alternative treatment; or
                                                                                              Referred back to regional hospitals for follow up


      Follow-up consultations at liver transplant clinic:                                           * Organ Registry Transplant System
            Inform patient of the meeting outcome and that he is                                        (ORTS)
             on the waiting list for cadaveric liver                                                      Ranking on the waiting list depends
            Probe for potential living donor and proceed to                                               on patients’ MELD/PELD score
             conduct living donor liver transplant if donor available                                     Regular update of MELD/PELD score
            Regular blood checking for updating the                                                       by liver transplant coordinator
             MELD/PELD score in ORTS*                                                                     Can be accessed by registered
                                                                                                           surgeons/physicians
                                                      Cadaveric liver available
                                                                                                    MELD: Model for End-Stage Liver Disease
                         Liver Transplantation Performed
                                                                                                    PELD: Pediatric End-Stage Liver Disease


    # For acute deteriorating patients, will direct transfer to intensive care unit (ICU) or general ward for work-up

    ~ MELD score calculation uses: Serum Creatinine(mg/dl), Bilirubin(mg/dl) and INR

    ~ PELD score calculation uses: Albumin(g/dl), Bilirubin(mg/dl), INR, Growth failure (gender, height and weight) & age at listing