BEFORE THE TRANSPLANT

 

Why is Geneva the national centre for liver transplantation?

After treatments were aligned at the national level, it was decided that Geneva would be the Swiss Centre for Liver Diseases in Children.

 

Is there no other centre in Switzerland that performs liver transplants?

Geneva continues to be the national centre for liver transplantation and all children living in Switzerland who need a liver transplant or a hepatobiliary surgery come here.

 

Is there anyone in the medical staff who speaks English?

A good number of our medical staff speak some German or English and several members of the medical surgical team speak German or Swiss-German, including Professor B. Wildhaber.  We also have a French-German” dictionary including the most frequently used terms and expressions available to you.

For parents who speak neither French nor German, the Red Cross has interpreters at their disposal. We call the latter in for multidisciplinary discussions and the various explications and information given to the patients.

 

Why is my baby yellow?

As a result of an infection, a dysfunction of the liver cells or a problem of the biliary ducts inside or outside the liver, your child may be icteric (jaundiced) at birth or later. This condition may persist for several weeks. It is important to inform your paediatrician and to have your child examined. Depending on the results of the investigations, your paediatrician will assess whether it is necessary to transfer your child to Geneva for an evaluation.

 

Can you cure my child?

Depending on the diagnosis made, your child may recover without surgical intervention or graft. If, however, the liver function is strongly altered and the risk of death exceeds the risk of living with the damaged liver, your child will be put on the transplant waiting list and then transplanted.

 

Why has the paediatrician not seen before that my child was not doing well?

Sometimes, it happens that the diagnosis is made late since it is difficult to evaluate jaundice in infants. A national program has been initiated to screen for certain liver diseases of children by means of a stool colour card distributed in certain maternity wards or available at www.basca.ch or from your paediatrician. This card allows to evaluate the colour of your baby’s stool: the more light-coloured or discoloured the stool, the greater the risk that the liver function is disturbed. In case of doubt, discuss this point with your paediatrician.

 

What is biliary atresia?

This is the total or partial absence of extra- or intrahepatic bile ducts. To sum up, your child has no bile ducts at all or not enough. The bile that normally flows through these ducts from the liver to the intestine stagnates at the level of the liver and causes your child’s hepatic dysfunction and jaundice.

 

What is the Kasaï procedure? Will it make a transplant unnecessary?

This is an intervention that consists in rebuilding the bile duct outside the liver by attaching an intestinal loop to the entrance of the liver (from which the bile should drain) in order to enable the bile to drain into the intestine and to relieve the liver. This operation must be carried out early in the child’s life in order to maximise its chances of success. It can allow to restore the bile flow from the liver to the intestine, prevent the liver from being damaged further and avoid a liver transplant. The liver transplant will always be necessary if the Kasai procedure is not performed.

 

What is cholangitis?

Following the Kasaï procedure, the intestinal loop attached to the entrance of the liver may cause cholangitis, that is an infection of the bile ducts due to intestinal germs. In this case, your child will receive intravenous antibiotics and will be under close supervision. His stay at the hospital will thus be extended.

 

Why must be child undergo a transplant?

When there is no treatment available to cure your child, your child’s liver function will decrease and change (jaundice, risk of bleeding, ascites,…) until the risk of death exceeds the risk of living with the damaged liver. In this case, there is no other solution than to replace the liver.

 

How long may be the waiting time for an organ?

At present, there is a lack of organ donors whereas there is a very great demand. Depending on the disease for which your child must undergo a transplant, waiting time may be long and range from several days to several months or even years.

 

Can I donate my liver?

If the physicians consider it possible (this depends on your child’s disease) that a portion of your liver can be transplanted to your child, a first evaluation may be performed. First of all, we will carry out some “blood tests” for both parents in order to find out who could be the potential donor (the blood type must be compatible). Then, other parameters such as weight, diet, health promotion and anatomy will be taken into account as well. As a general rule, donation from a deceased donor is preferred, since the living donation represents additional stress for the family.

 

Why can I not donate my liver to my child? Can another member of the family become a donor?

It happens for several reasons that the parents or a parent cannot be a donor. These reasons include liver problems or various health problems, overweight and the blood type. Close family members may also be donors in certain exceptional circumstances.