Before the transplant, we need to do a number of tests. These tests help us understand your child's health, decide whether a transplant is the right treatment, and determine the best timing for surgery.

This stage is called an assessment.

Some children feel quite well when they come to hospital for their assessment, while others may be very unwell.

During the assessment, your child will have several tests. Some tests may be uncomfortable or hurt a little, such as having a needle. Our team will explain each test and do everything we can to help your child feel calm, safe and comfortable.

After the assessment, you and your child will wait until the right time for the transplant. Your child needs to be well enough for surgery, and a suitable donor liver must become available.

Sometimes there can be a long wait for the right donor liver.

When a suitable donor liver becomes available, we will contact you and ask you to come to the hospital. Once your child arrives, we will begin preparing them for surgery.

From the time your child arrives on the ward, they will not be allowed to eat or drink. This is called ‘nil by mouth’. The stomach needs to be empty before the operation.

Before surgery, your child will usually:

• Be weighed.
• Have a bath with special soap and wash their hair.
• Change into hospital pyjamas.
• Have their hair shaved if they are over 12 years old.
• Have a small tube called a cannula put into an arm or leg. Fluids containing sugar and water can then be given straight into the blood because the child cannot eat or drink.
• Have a blood sample taken through the cannula. This means there is no need for another needle.
• Give a urine sample.
• Have swabs taken from the nose, armpit and any ‘wet’ sores to check for germs.
• Have two identification bands checked on their arms or legs. These bands have important details, such as the child’s name, doctor’s name and hospital number.

Before your child goes to the operating theatre, they will receive medication through their cannula. Some children may also be given medicine to help them feel relaxed and sleepy.

A nurse will accompany your child to the operating theatre and hand over important information to the surgical team.

Whenever possible, a parent or carer can stay with their child until it is time for the anaesthetic.

The anaesthetist will then give your child an anaesthetic. This puts them into a deep sleep during the operation. The medical team will make sure the child does not feel pain and does not wake up during the surgery.

A liver transplant operation can take around 12 hours, although this varies from child to child.

The next time you see your child will usually be after surgery in the Paediatric Intensive Care Unit (PICU).

After the transplant, your child will be taken to the Paediatric Intensive Care Unit (PICU) for close monitoring and specialist care.

When your child has been settled by the PICU team, parents and carers are usually able to visit. The PICU staff will explain visiting arrangements and keep you updated on your child's progress.

In the first few days after surgery, your child may be very sleepy and may not remember much about what is happening around them. We will give medication to keep them comfortable and help manage any pain.

Isolation:

After a transplant, protecting your child from infection is very important.

The medicines that protect the new liver also reduce the body's ability to fight infections. Because of this, your child will stay in a private room, known as isolation.

Your child will remain in isolation until the medical team decides it is safe for them to leave hospital.

To help prevent infections:

• Everyone entering the room must be well and free from illness.
• All visitors and staff must clean their hands carefully before entering.
• We may limit the number of visitors at certain times.

These simple measures help protect your child while their new liver is settling in and healing.