About Liver Disease

Liver disease occurs when illness or injury affects the functions of your liver. Liver disease can be grouped into 5 main categories

• Infection
• Immune system 
• Genetics
• Cancer 
• Other causes: fatty liver disease or chronic alcohol abuse

Surgeon: Dr. Ronald Cotton (Surgical Director)
Hepatologists: Dr. Avegail Flores (Medical Director) and Dr. Ruben Hernaez

What do kidneys do?

The kidneys filter the blood by removing waste products and fluid. They also regulate your hormones and maintain your potassium and sodium level.

What causes renal failure?

Some of the most common causes are diabetes, high blood pressure (hypertension), polycystic kidney disease, and infections. There is no cure for kidney failure. However, two treatment options are available: dialysis and transplantation.

Surgeon: Dr. Ronald Cotton (Surgical Director)
Nephrologists:  Dr. Nidhi Aggarwal (Medical Director), Dr. Venkat Ramanathan, Dr. Jenny Pan, Dr. Chandan Vangala

Find out more about Living Kidney Donations.

Surgeon: Dr. Wesley Mayer
Nephrologist: Dr. Jenny Pan

• Take your medications exactly as prescribed. Many medications must be taken at the same time each day. Never discontinue a medication or change the dosage unless instructed to do so by the transplant team. 
• Lab are scheduled at regular intervals. These labs are used to monitor the level of the medication in your system and determine medication change, as well as indicate signs of infection and/or rejection. Therefore, it is imperative that you keep your lab appointments. 
• Maintain proper nutrition to stay healthy. Regular exercise is also important to maintaining good health.

Your transplant team will educate you about the signs and symptoms of rejection. There are cases where you may experience rejection without having any symptoms. Therefore, it is imperative that you maintain all your lab appointments. (Blood tests taken during these appointments may show the first signs of a rejection.) For organ specific rejection symptoms, please contact your transplant coordinator.

What should I do if I notice any of the signs of rejection?

Immediately call your Houston VA transplant coordinator for instructions.

• Wash your hands, especially before eating anything
• Keep your hands away from your face and mouth 
• Avoid people who have colds or infections 
• Ask visitors not to come if they are ill 
• Brush your teeth twice daily and visit your dentist twice each year 
• Avoid handling animal waste

The request for transplant starts from the Veteran's primary VA medical center where the Veteran is enrolled. The Veteran’s primary VA physician will place a request for transplant evaluation. Then a transplant coordinator from your primary VA will ensure you complete the necessary tests in order to complete a referral packet. The referral packet is sent to the transplant center in Houston for review. If you are approved for evaluation for transplantation, you will receive a call from Houston VA to schedule your testing. Remember that you and your support person need to travel to Houston for an on-site evaluation.

During your evaluation, you and your support person will receive transplant education, followed by clinic visits with all team members. You will also complete some blood work, urine tests, and some additional testing as needed. The week after your evaluation your case will be presented to the Houston VA medical review board, who will review all information gathered from tests, interviews, your medical history, and your physical exam to determine whether or not you are an acceptable candidate for transplant. The Houston VA transplant team will contact you by phone with the results of the medical review board and you will also receive a letter with the results.

If you require dialysis during your on-site visit, the Houston team will schedule your dialysis treatment at the Houston VA.

Transplant Nurse Coordinator: Working with the transplant team, manages all aspects of your transplant care, both before and after your surgery. This nurse is responsible for coordinating your referral process, on-site visit, diagnostic testing, patient education, in-patient hospital stay, and discharge planning. This coordination will continue to be available to your referring VA after you return home.

Transplant Surgeon: Specializes in transplant surgery. One of the surgeons will conduct a thorough surgical evaluation of the patient prior to the surgery. This evaluation will assess your personal risks and the benefits of transplantation. The surgeon will also discuss any concerns you and your family may have about the surgery, the incision, or the recuperative period.

Transplant doctor (nephrologist or hepatologist): Specializes in the medical treatment of kidney disorders (nephrologist) or liver disorders (hepatologist)and works with the transplant team to ensure optimal functioning of the new organ. This physician completes a physical examination prior to the transplant surgery to assess the risks and benefits of surgery. The doctor will discuss any medical issues with you and your family.

Transplant Social Worker: Helps patients and families with non-medical issues that may arise before, during, or after transplantation. The social worker completes an evaluation on the recipients. As a licensed counselor, the social worker helps patients and families manage the complex emotional, personal, social, and psychological issues of transplantation at any point in the transplant process.

Program Support Assistant (PSA): Provides clerical and supportive services and serves as a vital communication link for you and the entire transplant team. The PSA coordinates your travel arrangements, lodging reservations, and makes your return clinic appointments for you. You will find the PSA helpful in answering your administrative questions.

Mental Health Provider: Will conduct a more in-depth evaluation and assessment of your psychosocial history. They will talk to you about any emotional or mental concerns you may have now or have had in the past, and any potential stresses that you may have related to the evaluation and transplant.

Registered Dietitian: Will perform a nutritional assessment and provide nutrition education. A good nutritional status is important for tolerating the surgery and recovery. The dietitian will also assess your height and weight to determine if you are within the correct BMI for donation.

Pharmacist: Will review your medication list, explain the medications and side effects. They will also refill your prescriptions.

Many other health care experts work with the transplant team to provide for your care. These professionals include physical therapists, respiratory therapist, chaplains, and nursing personnel and many more. Each team member plays a distinct and vital role in your care.

Your local VA Travel Office is responsible for coordinating and providing travel arrangements for you and your support person. If you have a potential donor, travel arrangements will be coordinated and provided by your local VA for your donor and your donor's support person.

The Houston VA Transplant Program will provide lodging to the potential recipient, donor, and designated support person(s), for the evaluation, follow up, and at time of the transplant. Lodging will be at hotels close to the Houston VA Transplant Center. These hotels offer a courtesy shuttle to the Houston VA.

No, the cost of meals is not included.

The VA does not pay for or reimburse you or your support person for any other expenses, including childcare, laundry, or lost wages.
 

The Veterans Health Administration (VHA) requires that every transplant candidate have a support person. The support person is there to help you throughout the workup process, during your on-site Houston evaluation, at the time of your transplant surgery, and in the months following your transplant. The VHA also requires you to have a backup support person, in case your primary support person is unavailable due to illness or other circumstance.

Over the years, numerous studies have looked at the success rates of transplant recipients. This research has shown that recipients who have good social support tend to have better transplant outcomes than those who have no social support. Unfortunately, not all transplants are 100% successful, which means you may have some complications, therefore having a support person can make a big difference in helping you cope with any complications.

The support person can be any person that meets the requirements below:

• Minimum age of 18
• Must be available to come with you to Houston for your on-site evaluation
• Must be available to accompany you at the time of transplant, and stay in Houston with you for 30 days after the surgery
• Must have no active substance abuse issues 
• Must be mentally and emotionally stable

Strong family support can be quite helpful to patients. However, the VA provides transportation and lodging only for the patient and one support person. If you choose to have additional support persons, they must travel and lodge at their own expense.
 

Once you are accepted as a transplant candidate you will be registered with the United Network for Organ Sharing (UNOS) before you are eligible to receive organ offers. UNOS is responsible for all transplant organ distribution in the United States. UNOS keeps track of the national transplant list and assigns the organs. There are different allocation policies per organ. For more information please ask your transplant coordinator.

What determines your place on the list is the severity of your illness, time spent waiting, blood type and other important medical information. Each time an organ becomes available, UNOS prints a new list. UNOS then notifies the transplant center that an organ is available for a recipient who is listed at that center.

While on the waitlist you will receive information for your primary VA on emergency travel. Please make sure to keep this information readily available.

There is no definitive answer as to how long it will take, but candidates can be on the list for years. 

For current information about the waiting list, visit UNOS.

At the time of an organ offer you will receive a call from the transplant coordinator in Houston notifying you of the organ offer. Instructions will be given to you for when you will need to come to Houston. You will use the emergency travel information given by your primary VA to travel to Houston. Follow all the instructions given to you by the Houston transplant coordinator. After the transplant you will be required to stay in Houston for at least 30 days.