Most patients have transplant surgery at a center near their home. It is convenient and one is in familiar surroundings. However you are not required by UNOS to receive care at any particular center. Some health insurance policies may mandate certain centers, but otherwise you can select where you want to have your transplant. There are many factors to consider.
It would not be unusual for your specialist to recommend a transplant center for you, and he or she may urge you to have your surgery in a center that is familiar or because the specialist works there. But remember it is your surgery, your health, and this is your decision. That is why you will need to do research on the facility you are considering. You may list at more than one center if you are able to afford the process and can handle the numerous evaluations. Many of our members have listed at more than one center.
A UNOS brochure that explains the listing system is available by clicking here.
Researching a center
If you are considering a specific transplant center you will want to find out more about that center’s recent one-year survival rate for liver transplants (last two years), the average MELD score upon transplant, the number of liver transplants done annually (minimum for UNOS certification is 12 annually), the experience level of the surgeons, the process they have in place for care post-surgery and for follow-up care, the average length of stay after surgery, and other questions.
If you decide to choose a center that is distant, you will need to look into the hospital’s support for waiting patients—often they can provide reduced rate arrangements for hotels, short term apartment lists, and so on. The liver social worker is the resource for that information, and the hospital’s web site.
If the center you are considering is not near your home, you will need to ask about the policies regarding the distance you’ll need to stay within while awaiting a transplant. Generally at a lower MELD or PELD you will not need to be particularly close to the transplant center. But as you get nearer to a transplantable MELD or PELD score, you may have to make arrangements to stay closer.
If you decide to list at more than one center, you need to be aware that a second listing in the same area may not be advantageous because the waiting list is combined with nearby centers. All transplant hospitals in the area merge their patient lists for allocation of organs. If you plan to list at another center, you would want to go into a different UNOS area or region, where you would be on a different waiting list, served by a different organ procurement organization. Some areas of the country have more organs available because these areas have a higher rate of organ donation. The UNOS website has a wealth of information that can help you make a decision whether to list at more than one center. The UNOS site is available by clicking here.
Click here to research Organ Procurement Organizations (OPO) by state and/or street address. Generally, all transplant centers in a specific city are served by the same OPO. Some very large cities may be served by more than one OPO.
Some considerations to help with the decision on where to go for surgery are whether your insurance coverage accepts the centers you are looking at, how you would manage being away from home, transportation to the center, caregiver and family support out of town, the financial impact, and other matters. You will need to ask about post-surgery follow-up care: specifically if you can transfer your care to a center near to your home, or if you want to travel for follow-up to the center that performed the surgery.
Going out of the country for a transplant is generally not advised. “Medical tourism” areas have different standards for transplant and in many cases patients are more at risk for poor outcomes in these situations.