Liver transplantation

Living transplant-recipients

Application review

Living liver transplantation is another option for patients who have the end stage liver diseases (except end stage liver cancer) to save or extend their lives. Most end stage liver failure patients are suitable for liver transplant unless the patient has other contraindication, such as septicemia, aids, malignant tumor of outer liver, severe cardiovascular disease, drug addiction or alcohol addiction.

The assessment is to measure the suitability of patient and to provide important information for the patient.

Examinations and assessments：

  1. medical records review
  2. blood type and tissue matching
  3. Regular blood, biochemical, urine and stool tests
  4. Virology examination
  5. infection assessment
  6. breast x ray and abdominal ultrasound (or abdominal CT)
  7. Optional gastroscopy
  8. electrocardiogram
  9. psychiatrist consultant
  10. social worker consultant
  11. nutritionist consultant

If patients are also elders or having diabetes, they need to take further cardiac examinations, such as cardiac ultrasound or systolic function. Elder women need to
take breast and cervix examinations. Elder men need to take prostate examinations and bladder function examinations if having difficulties of urination. Oral health is also important. If you have cavities, you need to take treatments immediately. Otherwise, they may become the cause of transplant infections.

ABO-incompatible liver transplantation may result in an immune respond of B cell and then cause rejections. Therefore, it is necessary to have B cell antibody (rituximab) before the surgery, plasmaphresis before or after the surgery and inject IVIG, before and after the surgery. The successful rate is comparable with same or compatible blood type grafts. The cost of the medicine before and after the surgery and plasmaphresis depends on each patient’s condition. The cost is around NT$ 100,000 to 200,000.

Fee

Taiwanese and residents：
Taiwanese and residents please refer r to the standard charge of outpatient clinic and emergency service.

Foreigners：
Foreigners who do not have the national health insurance will be charged by international medical standard fee.

1、Clinic/emergency：

  1. Registration: NTD $500
  2. Examination fee: NTD $1500
  3. Special service fee (you will have a coordinator helping atsite): NTD $200 per visit
  4. Psychiatric consultation: NTD $2,500
  5. You may be charged by other medicine tests and treatments

2、Stay in hospital：

  1. Inpatient examination and nursing fee: three times the price of the national health insurance standard charge
  2. General service fee: NTD $5,000 per stay
  3. NHI covered services/treatments: 2.21 times the price of the national health insurance standard charge
  4. Self-paid services/treatments: 1.7 times the price of the self-pay standard charge from department of health, Taipei city government. .

Depending on the treatments, we will estimate the medical cost. You will need to pay the deposit before staying in the hospital. The patient will only pay for the service and treatments they use (the hospital will return the rest of the money)

Payment options（IMSC）

  • Exchanging new Taiwanese dollar
  • Credit card (VISA card, Master card and china unionpay card)
  • Transfer

Clinic/inpatient arrangements

We will arrange the following living transplant examinations:

Blood tests:

  1. Blood type, functions of liver and kidney, hepatitis ABC, the virus quantity of hepatitis BC (NTD $3,000 each, self-pay), syphilis, AIDS, blood counting, hemostasis, tissue matching, autoimmune system, virus check, tumor indexes, PIVKA II (for liver cancer patients, NTD $1,750, self-pay), Human T-lymphotropic virus (HTLV-I/HTLV-II), thyroid function, arterial blood oxygen, latent tuberculosis infection (NTD $,2OOO, self-pay)

     

  2. Image check:
    All patients: liver transplant CT, 3D image synthesis (NTD $3,OOO, self-pay), abdominal blood vessel ultrasound and chest x ray.
    Liver cancer patient: chest CT, whole body bone scan and positron emission tomography (if needed, NTD $40,OOO, self-pay).
    Female: Breast ultrasound and mammography.

     

  3. Consultations
    Psychology division: evaluating if the patients are in good medical, social and psychological conditions.
    Cardiology: cardiac ultrasound for evaluating if the cardiac function is suitable for the transplant surgery.
    Colon and rectal surgery division: colonoscopy and proctoscopy for evaluating if the rectum, colon or ileum having malignant tumors.

     

  4. Gynecology and obstetrics: pap smear test and ultrasound for
    evaluating if having malignant tumor.

     

  5. Examinations of stress Free endoscopic and colonoscopy are at the
    patients’ own expenses, NTD $4,000 for each, NTD $6,000 for
    together.

Treatments

A living liver donation is performed under general anesthesia, therefore, during the surgery, you will not feel anything. In order to detecting the central venous and blood pressure, a central venous catheter will be inserted in the right part of your neck, and an artery catheter will be inserted in your upper limbs. The use of a bladder Foley catheter for monitoring urine output is also necessary. The surgery is performed in abdomen. The liver with cirrhosis will be removed from the incision that looks like a Mercedes-Benz logo. Besides the ill liver, part of the arteries and vein connecting with the ill liver, common hepatic duct and the whole gallbladder will also be removed. Then, place the new liver in the abdomen. The resource of new liver may be a deceased donor or a closed-relative living donor. The new liver will be connected with your liver veins, inferior vena cava, hepatic portal vein, liver arteries. When they are all matched, the new liver will receive blood flowing through. Then, the doctor will connect the new liver with your bile ducts and small intestine, and then create a new bile drainage duct. However, the new liver does not come with the gallbladder. Sometimes, it is necessary to remove the gallbladder or ligate the left kidney vein during the surgery. After the surgery, the doctor will place some drainage tubes in the abdomen for the bleeding drainage and observing biliary leaks or biliary bleeding.

Nursing care plans

  1. To preventing the rejections damage the new liver, you need to take anti-rejection medicines for the rest of your life. The anti-rejection medicines are also known as immunosuppressive drugs. Taking the medicines may lead to some complications, including higher chance of having cancers and infections, damage of kidney and nerves and metabolic disease (hyperglycemia, hyperuricemia and hyperlipidemia). You need to regularly test the concentration of medication and certain indexes of blood.

     

  2. You may have psychological or metal issues due to the surgery and the anti-rejection medications. With these conditions, you may take counseling or medical treatments.

Applying for medical records/certificate of dianosis

The duration and procedure of applying for medical records

1、Applying options

  1. 「Online」。
  2. Counter service
  3. Applying online (taking about 2~7 business days) willsave your time instead of waiting in the hospital. However, when pick up the copies, you need to bring your id to the counter and pay.
  4. You can directly apply at the medical counter without registration or seeing a doctor.
  5. When applying for your copies, please tell us the term, the services/treatments and the duration of your record. If you do not know how to find the information, you may ask your doctors for help when visiting them.
  6. You need to pick your copies within 1 month after informed. If you do not do so, you will need to reapply.
  7. For videos or images copies, please apply at the image counter 8 of radiation department on the 8 th floor in the Zhongzheng building.

2、Procedure

  1. Please bring your ID and related documents, take a number at the counter and wait your turn.
  2. Fill out the application form.
  3. The staff will verify you application.
  4. Pay and collect your copies.
  5. For the requirements of applicant and enclosed documents, please refer to Here 

The duration and procedure of applying for certificates of diagnosis

  1. The patient applies for certificates of diagnosis while staying in hospital will need to prepare the draft made by your doctor. Then, bring it to division of medical affairs admission (the inpatient counter on 1st floor in the Zhongzheng building) for an official copy.
  2. Chinese copy：NTD $100 for the first copy；NTD$50 for the second and more copies English copy：NTD $200 for each copy.
  3. Outpatients who needs to apply for the certificates of diagnosis please refer to Here
  4. For reissuing certificates of diagnosis (same copy from the one you have applied before), you need to provide your identification (as the list below) and an application. (Download：(application）
  5. For the requirements of applicants and enclosed documents please refer to Here

Revisits/follow-ups

The donor can be discharged within 1-2 weeks if no complications happen. The donor can be back to his/her normal life after 1 month. The doctor will give you further explanations after you pass the primary review.