ADVERTISEMENT
ADVERTISEMENT

Q. There is a six-month waitlist for liver transplant. What are our options?

Answered by
Dr. Anshul Varshney
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 06, 2018

Hello doctor,

My brother, 46, has ALD cirrhosis. He was admitted to a hospital. Day-6 now. And is undergoing withdrawal and other treatment. MELD score is 22-24; ammonia 40 (down from 70). Low platelets, lot of bruises from falling pre-admittance. Signs of advanced hepatic encephalopathy. Treatment includes Rocephin, Librium, Lasix, Lactulose, Keppra, Magnesium and multivitamins, Presnison, Rifaximin, and Spironolactone.

Prognosis is very unclear as assessments are day by day. Due to the UNOS policy, any transplant (including live donor, which I would do) will not happen for six months due to a waitlist. It is almost a death sentence and unfair. Especially in the context of a live family donor.

What else can we do to immediately treat his degrading condition from a medical perspective? He has zero energy, cannot feed himself, barely can talk. Just last week, he was walking around and fairly alright (according to wife).

Can we introduce alternative medicine?

ADVERTISEMENT
#

Hi,

Welcome to icliniq.com.

First of all, you need to understand that alternative therapies do not work in acute severe states. You can consider them later once he recovers. At this point of time, apart from medical management that is already being done, you can discuss with your doctor for liver assisted therapy in which there is a machine that acts as a pseudo liver. This is used till a liver transplant is arranged.

The second option is shifting him to countries where you can still go for emergency transplant provided you have a donor. Discuss with your doctor regarding partial liver transplant in which a live donor can give a partial portion of his liver to him. That donor can be from your family. You need to check if your hospital provides these facilities.

For more information consult a medical gastroenterologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-gastroenterologist

Hello doctor,

Thank you very much. A few more questions:

  1. Any specific and key questions that I should ask my gastroenterologist?
  2. Our biggest concern is getting him out of this very very lethargic state which has onset him so he can have a clear mind to self-motivate - hard to believe it is just the meds and hard to believe it is the liver as figures are same or slightly better.
  3. We think he may also have hepatic encephalopathy. So, anything else we can do apart from current meds?
  4. When would assisted liver machine (I researched MARS) be advisable? Any more details appreciated.
#

Hi,

Welcome back to icliniq.com.

You can discuss my opinion with your gastroenterologist.

I am talking about MARS only and if it is available in your country, you may consider that under the guidance of your treating doctor.

Yes, his lethargic state is because of hepatic encephalopathy only. The best treatment for that would be high bowel wash with Lactulose along with oral Rifaximin. I suppose your doctors must be doing that.

For more information consult a medical gastroenterologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-gastroenterologist

Thank you doctor,

Are you able to tell me anything we can do about his quick onset of lack of good dexterity with arms and hands? Is this due to the liver and body simply being sober for seven days now after 10 years of drinking? Also, any insight on the MARS dialysis appreciated apart from what I can find from the internet.

#

Hi,

Welcome back to icliniq.com

To be honest, your doctor's treatment is very good. You can ask him for more albumin transfusions for strength. You can ask your doctor for injection Hepamerz (L-Ornithine-L-Aspartate and Pancreatin) for a little more support.

Availability of MARS in your country and your doctors experience with it depends on how easily he can get that.

For more information consult a medical gastroenterologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-gastroenterologist

Hello,

Thanks this is helpful. If his liver gets progressively worse and they do not transplant till six months of sobriety here, if his life depends on it, could he get a transplant in your country? Is this common?

#

Hello,

Welcome back to icliniq.com.

Yes, you can talk to your doctor about it. There are centers here which are pioneers in liver transplant.

For more information consult a medical gastroenterologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-gastroenterologist


Was this answer helpful?

 | 

Same symptoms doesn’t mean you have the same problem. Consult a doctor now!



Related Questions:
I had fatty liver.Do I have chances of developing cirrhosis?

.. have read through your query and attachments in detail. (attachments removed to protect patient identity) Please find my observations below. Having gone through your reports in detail, cirrhosis is unlikely as your most recent ultrasound done on...   Read full

Through histopathology, can we get 100% accurate diagnosis?

.. by biopsy is the most confirmatory method for many pathological conditions. Hyperlipidemia can lead fatty liver condition, which can be because of alcohol as well. From histopathology examination, it can be surely said that whether it is an infe...   Read full

Does normal diet cause edema in a liver cirrhosis patient?

.. gone through the details posted. Edema in cirrhosis patients is mainly due to low oncotic pressure in blood vessels because of low albumin. Cirrhosis compromise the synthetic function of the liver and so albumin production gets decreased. It is th...   Read full

ADVERTISEMENT

Also Read Answers From:

ideaComprehensive Medical Second Opinion.Submit your Case

Also Read


Management of Coronasomnia
Coronasomnia refers to increased sleep problems among people during the COVID-19 pandemic. Read the below article to get...  Read more»
Balantidiasis - Causes, Signs and Symptoms, Diagnosis, Treatment, and Prevention
Balantidiasis is a rare bacterial infection caused by a parasite called Balantidium coli. Read the article below to know...  Read more»
JAK Inhibitors in Treating Rheumatoid Arthritis
Doctors mainly suggest JAK or Janus kinase inhibitors for patients with rheumatoid arthritis to ease their symptoms. Rea...  Read more»

Ask your health query to a doctor online?

Ask a Medical Gastroenterologist Now

* guaranteed answer within 4 hours.

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.