FAQ: Getting a 肝脏移植手术
- Who gets priority for a liver transplant?
- Is there a way to expedite a transplant?
- What's an "ideal liver"?
- What's a non-ideal liver?
- 我如何决定是现在取一个不理想的肝脏还是等待一个理想的肝脏?
- How do I opt into the High Risk 肝脏移植手术ation Program?
Who gets priority for a liver transplant?
Throughout the United States, 等待肝移植的患者会根据病情的严重程度进行优先排序, 通过所谓的终末期肝病模型(MELD)评分来衡量. 该评分通过血液测试来确定你在未来三个月内需要肝脏移植的迫切程度. 你病得越重, the higher your MELD score; scores range from six (less ill) to 40 (critically ill).
在旧金山湾区,需要肝脏移植的人比捐赠者多得多. Because the waiting list is so long, 你必须有很高的MELD分数才能在加州大学旧金山分校或其他当地的移植中心进行移植. Most patients are quite sick by the time they receive a transplant, and some will die before they can get one. 有些病人病情突然恶化,病情严重到无法接受移植.
Is there a way to expedite a transplant?
是的. 一种选择是去国内某个地区的移植中心,那里的等待名单更短,患者得到的移植手术MELD评分远低于旧金山湾区的需要. If you're interested in this option, 向你的保险公司要求转介到这样的中心或搜索器官共享联合网络 网站.
另一种选择是接受活体捐赠者的肝脏 living donor transplant. Living donor transplants carry risks for both the donor and the recipient, and not everyone is a candidate. If you'd like to know more about living donor transplants, ask your hepatologist or liver specialist, your surgeon or your transplant coordinator.
第三种选择是参加我们的高危肝移植项目. 在这个节目中, 当一个被认为“非理想”的肝脏可用时,患者同意与他们联系. Many transplants using non-ideal livers are successful, but these livers may carry a higher risk of not working well, or of transmitting an infection or cancer. 如果我们觉得你在等待移植期间死亡的风险大于接受非理想肝脏的风险,我们可能会为你提供一个非理想肝脏.
An ideal liver comes from a healthy young person who has died. 理想的肝脏更有可能工作良好,不太可能传播癌症或感染. 在美国,大约三分之一的肝脏移植来自理想的捐赠者. This means it's impossible for every patient to get an ideal liver.
重要的是要注意,即使是理想的肝脏也有可能感染或癌症. The risk if low – probably less than one in 100 – but it's not zero. It's impossible to test donors for every type of infection or cancer, 测试可能检测不出问题,我们可能不知道捐赠者是否有行为, 比如静脉注射药物, which would make the liver more risky. These are risks that every transplant recipient takes.
许多不理想的肝脏可以正常工作,只有很小的传播感染或癌症的风险, just like an ideal liver. Other non-ideal livers carry higher risks. 如果你的医疗团队认为你在等待移植期间死亡的风险大于非理想肝脏的风险, they may offer you the non-ideal liver.
来自以下捐赠者的非理想肝脏有较高的传播感染或癌症的风险:
- A donor who was infected with hepatitis B. These livers work well but recipients need to take, for the rest of their lives, a medication that prevents them from developing hepatitis B. This medication prevents infection in more than 90 percent of cases.
- A donor who was infected with hepatitis C. 我们不会使用这些捐赠者的肝脏,除非接受者已经患有某种特定类型的丙型肝炎, 称为基因I型, and only when the liver isn't scarred from the hepatitis infection. 在这些情况下, 结果似乎与患者从没有丙型肝炎的捐赠者那里接受肝脏一样好.
- A donor who had cancer. We sometimes use livers from donors who had a history of cancer, but only when we believe the risk of transmitting cancer is low, based on the type of cancer and the stage. 当你被要求提供器官时,外科十大赌博平台排行榜会和你讨论癌症的风险.
- 在过去一年内曾入狱、使用过静脉注射药物或与高危伴侣发生过性关系的献血者. 这些献血者可能有更高的传播艾滋病毒、丙型肝炎或乙型肝炎的风险. We test for these viruses, 但如果病人最近被感染,测试可能无法检测到它们. 我们认为这些肝脏感染的风险很低,对一些病人来说, it's probably below the risk of dying while waiting for a transplant.
We don't use organs from donors who test positive for HIV.
以下几种肝脏不太可能传播感染或癌症, but they carry a higher risk of not working well:
- A split liver or a partial liver transplant. 年轻捐赠者的肝脏可以分成两部分,移植给两个接受者. 取一块肝脏而不是整个肝脏可能会增加出血的风险, problems with the bile duct and problems with the liver not working well.
- Livers from older donors. 来自55岁及以上捐赠者的肝脏对丙型肝炎患者的作用似乎不如来自年轻捐赠者的肝脏. 然而,对于没有丙型肝炎的患者,它们似乎同样有效.
- Livers donated after cardiac death. Most organ donation occurs after brain death, meaning the donor has been declared brain dead but all organs, including the heart, 继续工作. 如果在心脏停止跳动后取出肝脏,也就是心脏死亡后的捐赠,风险似乎会增加. 肝脏可能无法正常工作,接受者可能需要紧急进行第二次移植. There also appears to be a higher rate of bile duct problems, 这意味着接受者可能需要更多的程序,或者肝脏可能无法正常工作. And the risk of transplant failure appears to be 5 to 7 percent higher.
当一个非理想的肝脏可用时,我们会给你我们对该肝脏实际增加的风险的最佳估计. 如果你觉得那时还没有准备好承担更高的风险,你可以决定等待另一个肝脏. Doing so will not affect your status on the waiting list.
如果你的肝脏病情加重,这个决定的风险和好处可能会随着时间的推移而改变. Our team is available to help you make the decision that's right for you.
How do I opt into the High Risk 肝脏移植手术ation Program?
Contact UCSF nurse Ana Marie Torres at (415) 353-1888 or (800) 548-3789. She will give you a form to sign, 当不同种类的非理想肝脏可用时,同意与他们联系. 再一次。, you can refuse a non-ideal liver at any time; doing so will not affect your status on the waiting list.
加州大学旧金山分校健康 medical specialists have reviewed this information. 它仅用于教育目的,并不打算取代您的十大赌博平台排行榜或其他医疗保健提供者的建议. 我们鼓励您与您的供应商讨论您可能遇到的任何问题或疑虑.