Liver Transplant Postponed

[kymo1]

My father was recently accepted for transplantation at the University of Washington.  His last MELD score was 24 and he was told by the transplant nurse that he was "#1" on the list for his blood type. He has since been hospitalized (at our local hospital - not U of W)  for a bruise to his leg which has caused much internally bleeding/swelling in the leg.  He has received many transfusions, but they can't seem to get the bleeding to stop.  
U of W has learned of his hospitalization and put him "on hold" for the transplant until he has "no active bleeds" and "can walk into the transplant center himself".  Is this a normal requirement of transplant patients?  Isn't it common for liver transplant patients to be hospitalized for bleeds all the time?

Additionally, the hospital he is currently at is very anxious to transfer him to U of W (4 hours away from home) or another hospital with a "GI service" (their words).  What is the benefit of being in a different hospital?  Would a "GI service" be better able to handle the bleeding in his leg b/c they deal with liver patients?  We just don't want to see him moved to a hospital far away needlessly.

Sorry for the long explanation. Thanks ahead of time for your response.

[Thomas D Schiano, MD]

india will do a live donor transplant but it will cost a lot of money.  there has got to be a way that he can get health insurance and get medicaid.  this should not be a reason for transplant denial if he is a US citizen.  he may need to get admitted to a hospital that has a transplant program such as U of Miami or mayo clinic jacksonville or gainesville or tampa general.  once in the hospital the social workers may be able to work something out.

[Thomas D Schiano, MD]

its typical for patients to be temporarily inactivated on the transplant waiting list when acute issues are going on.  I think there is no special advantage of being at a hospital with a GI service but I am really concerned that the bleeding is persisting.  This can set the stage for complications from transfusions, infections, etc. It might be better to have him at a big university hospital so the experts can put their heads together to come up with a way to stop the bleeding, ie the use of activated factor 7.  It might be worthwhile to transfer him.

[Thomas D Schiano, MD]

i think he should try and get admitted to one of the centers that i outlined above or on a neighboring state such as UAb or Emory.  They will definitely help him.  That is a better option than going abroad. when he would return he would still need to pay for the very expensive medicines which will be a problem if he has no insurance

[maiden1959]

I told my brother that Broward General has a transplant program, but he says they will just let him die.  He is scared and he is not thinking clearly.  When you say India cost a lot of money...you are right but they said they do not provide the liver and they told my brother it
would be around $60,000.  I have about that much in my 401 k but do you know anyone who and done this? Every place I checked they require a living donor.  I was told I am too
old,,,63.  U of Miami, is in money problem it is not like before...Do you know anyone you can recommend, someone who would really help.  I would do anything I could to save my brother but he is in bad shape, there is little time.. His legs are badly swollen, difficult for him to walk, the diuretics are not working is there anything that will bring down the swelling?  If I take him to the hospital would they be able to help that.  he fighting me, he says he does not want to die there. I don't know how much time he has,,please help me I am running out of time

[maiden1959]

Please I need to know where I can get help for my brother-I don't know how much time he has left, he has hepititis c and cirrohsis--he has no insurance I am desperate.  I want to take him to the hopital anyway but he says they will let him die.  I would give my liver if I could I am O negative blood type is that good.  I will do anything for him.  I raised him and
I already lost 1 brother at age 37, this brother is 50 I will die if anything happens to him..
there has to be someone that can help us...if he cannot get help here someone told me
go to India..we don't have a lot of money but I  would use whatever I have to save him.
he has not had a drink since he has been with me..over 12 years he is such a kind,
good man.....please can you help. we live in ft lauderdale ---GOD BLESS YOU

[Thomas D Schiano, MD]

i pray that things work out OK.

[kymo1]

Thanks so much for your timely response. I've passed the information on to my mom (at the hospital now) and we will talk more seriously to the doctors about the possible benefits of moving him to to a larger hospital to get stabilized.

I emailed months ago about my dad's rejection from Oregon Health Sciences University.  Your advice about trying another transplant center is part of what encouraged us to keep going and now he is accepted at U of Washington. It's such a blessing to have a doctor like you as a resource.  I appreciate your time and I know you are saving lives by patiently answering questions on this forum.