Liver Disease & Transplant Center

Liver Transplantation

Liver transplantation is a highly successful treatment for patients with chronic end-stage liver disease (cirrhosis), certain types of liver cancer (such as hepatocellular carcinoma or hepatoma) and some cases of sudden onset liver failure.

Liver transplantation is a complicated surgical procedure and understanding the process and the potential risks is important in order to make an informed decision as to whether liver transplantation is right for you.

This page will help you learn about the transplant process and answer questions that you may have about whether transplantation is an option for you.


Step 1: The Evaluation

There are many ways in which you can get an appointment to be seen at the Hartford Transplant Center. Your providers will help arrange this for you (or you can complete the online referral form yourself). The first step in the process involves a thorough evaluation by the transplant team to determine whether you are a suitable candidate for a liver transplant. Details of this evaluation are discussed at length in the Informed Consent for Liver Transplant Evaluation Process (ENGLISH | SPANISH) document that you will sign before beginning the evaluation process. The evaluation process can be done as an outpatient and/or as an inpatient.


Step 2: The Liver Eligibility List

If you successfully complete the evaluation your name will be placed on the UNOS (United Network for Organ Sharing) eligibility list for a liver transplant. While on the list you will have regular appointments with the transplant team and your lab and imaging results will be checked periodically. Your place on the eligibility list will change based on the MELD (Model for End-stage Liver Disease) score. The MELD score is a number from 6 to 40 that is calculated based on your lab results. The MELD score measures how sick your liver is making you. The higher the score – the higher your name appears on the list. Most liver recipients receive their transplants when their MELD score is at 28 or higher.


Step 3: Liver Donor Offers

Once you are on the list the transplant team can receive liver offers on your behalf. The number of offers you receive will depend on your MELD score and will come from donors whose blood type is compatible with yours. Offers are carefully reviewed by the team. You will only be notified of a liver offer if we are confident that the liver is suitable for you and will work well.

Donor livers can transmit diseases despite the detailed review done by UNOS and the transplant team. The United States Public Health Service (PHS) 2020 Guidelines identify high risk situations for potential disease transmission by hepatitis B (HBV), hepatitis C (HCV) and HIV. Any donor who may potentially transmit HBV, HCV or HIV is referred to as a PHS Risk donor. If you are found to be an acceptable candidate for the UNOS waitlist you will be eligible for offers from all deceased liver donors including those with the characteristics mentioned above. This does not mean that you must accept these offers, but simply that you will be eligible to receive these offers. The ultimate decision is always yours and the team will discuss this with you at the time an offer is made to you.

Certain other conditions such as the age of the donor, fat content of the donor liver, and the type of donor surgery (brain dead vs. cardiac death) may increase the risk of complications after surgery.  If any of these risks may affect your liver offer we will discuss these with you before you decide to accept the offer or not. If you decline an offer you will not lose your place on the list.


Step 4: Transplant Surgery and Possible Complications

During a liver transplant your entire diseased liver is removed and replaced with a new whole donor liver. Since the donated liver in these cases comes from a deceased person the procedure is known as deceased donor liver transplantation (DDLT).

A liver transplant takes about 6-8 hours to perform. There are always two fully trained transplant surgeons in the operating room in addition to a team of highly skilled anesthesiologists, nurses, and perfusionists.

Following surgery you will be in the intensive care unit (ICU) for a few days. In most cases you will be able to eat, drink and get out of bed within 2-3 days.  At this point you will be ready to move to the Transplant Floor for the remainder of your hospital stay.

Most recipients can expect a 10-14 day hospital stay and a total recovery time of 6-10 weeks. Your own recovery may be quicker or slower depending on how you were feeling at the time of your surgery and if any complications occurred.

No type of surgery is risk-free. We will only perform your liver transplant when we believe that the benefits to your health outweigh the risks.

These risks can be divided into short-term and long-term. Liver transplants have about a 92-95% success rate. Death from all causes following transplantation occurs in about 5-8% of patients within the first year. The data specific to our center will be provided to you.

Short-term risks following liver transplantation include the following. Infections (pneumonia, wound infections, etc.) are treated with antibiotics either by mouth or intravenously. Acute Rejection (detected by lab results and/or liver biopsy) is treated with medications by mouth or intravenously. These treatments are highly successful and rejection is rarely a major problem following transplantation unless you refuse to follow our instructions (non-compliance). Technical complications such as bleeding, bile duct or vascular complications, etc. are typically treated by surgery or interventional procedures. Delayed function or primary non-function of the liver (during the post-operative period) is an extremely unusual occurrence - rarely a second transplant may be required.

Long-Term Risks of Liver Transplantation include the following. Recurrent liver disease or cancer (recurrent or new onset) can be treated by your hepatologist or an oncologic specialist. Chronic Rejection (detected by lab results and liver biopsy) is a rare event which can lead to liver failure over months to years and may require a second transplant. Infections (pneumonia, gastrointestinal, etc.) and newly discovered malignancies such as skin cancers and lymphoma can occur at any time following liver transplantation due to the ongoing need to take immunosuppressive medicines. As time passes the risk of these medication-related complications decreases.

Each of these complications has a specific type of treatment and we promise to discuss your options and give you the best possible treatment for your specific situation.


Step 5: Life After Transplant

Liver transplantation is a highly successful advanced therapeutic modality. We expect that you will return to a state of good health and live a normal life as long as you follow our guidance, use common sense and take care of yourself and your new liver. Keeping your appointments with us and taking your medications as instructed are critical to success. You will start taking medications to support your new liver right after surgery. Early on you may take up to six new medications, but after a few months most patients are able to cut back to two or three medicines and, after one year, many recipients are taking only one or two medications.

We will always be here to guide you and answer questions. Success is ultimately a team effort – and you are the most important part of that team!

Please ask questions and get the answers you need. We want the best for you – for life!

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Meet our Liver Transplant Surgeons:

Name Specialties Location
Dar, Wasim, MD, PhD Dar, Wasim, MD, PhD 860.972.4219
  • Transplant Surgery
  • General Surgery
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  • Hartford
Emmanuel, Bishoy, DO Emmanuel, Bishoy, DO 860.972.4219
  • Transplant Surgery
  • Hartford
Morgan, Glyn, MD, MSc, FRCSC, FACS Morgan, Glyn, MD, MSc, FRCSC, FACS 860.972.4219
  • Transplant Surgery
  • General Surgery
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  • Hartford
Serrano, Oscar K., MD Serrano, Oscar K., MD 860.972.4219
  • Transplant Surgery
  • General Surgery
  • Hepatobiliary and Surgical Oncology
  • Surgical Oncology
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  • Hartford

Meet our Liver Transplant Hepatologists:

Name Specialties Location
Einstein, Michael Mark, MD Einstein, Michael Mark, MD 860.972.4262
  • Gastroenterology
  • Internal Medicine
  • Transplant Hepatology
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  • Hartford
  • Bloomfield
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Richardson, Elizabeth Ann, DO Richardson, Elizabeth Ann, DO 860.972.4262
  • Gastroenterology
  • Internal Medicine
  • Transplant Hepatology
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  • Hartford
Sotil, Eva, MD Sotil, Eva, MD 860.972.4262
  • Gastroenterology
  • Internal Medicine
  • Transplant Hepatology
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  • Hartford
Swales, Colin Thomas, MD Swales, Colin Thomas, MD 860.972.4262
  • Gastroenterology
  • Internal Medicine
  • Transplant Hepatology
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  • Hartford
  • Bloomfield
  • Glastonbury
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