Temporary relocation guide

Step 4: Treatment pathways

What happens	Immediate outcome	Longer term outcome	Cost/PTSS/HHS implications
If accepted for transplant
If accepted for placement on the waiting list for a liver transplant, the longer-distance regional patients must temporarily move to within a 2 hour driving radius of Brisbane. If already living within 2 hours driving distance of Brisbane—simply stay put, no need to move. Being near the PAH is vital. The majority of patients listed for transplant choose to move to  an area near PAH. If patients choose to live further away but still within the 2 hour radius, they need to have an excellent transport plan for getting to the PAH before and after the transplant.	If in reasonable health, the newly accepted regional patient usually returns home for a few weeks to prepare for their temporary move to the Brisbane area. If too unwell to return home, patient begins their wait for liver transplant in Brisbane. The waiting time for a transplant is always unknown. A donor liver could be several days or 1 to 2 years away.	The patient waits for a transplant, which happens when a donor organ  becomes available. If transplanted, the patient is hospitalised for 7 to 10 days, on average after the transplant and attends daily or near-daily liver transplant clinic for several weeks. The patient then continues attending weekly clinic appointments for 3 months or so, after the time of the transplant. All patients must be ready and able to attend the PAH for up to 3 months post-transplant. The length of time for which patients and their carers need to stay near the hospital during the post- transplant and discharge timeframe, is determined by how far their home region is from the PAH, and their post-transplant medical condition. Patients from North Queensland for example, usually stay in the Brisbane area for 3 months post-transplant. Patients who live within a few hours drive of Brisbane generally, stay in the Brisbane area for 4 to 8 weeks after their transplant.	Long term financial support is available for PTSS eligible patients.
If accepted for transplant awaiting further tests or treatments
The patient is not placed on the waiting list yet until further investigations or treatments occur, for example, dental work. The results of these tests or treatments could determine if the patient will be listed or not.	The specialist will decide whether to discharge the patient to their home region for the time being, or request they stay nearby.	Once the outcome of the additional investigations or treatments is known, a decision will be made by the specialist as to whether the patient is listed for transplant or not.	Regular PTSS support as described in this document is available to help eligible patients with transport and accommodation costs. This enables patients to obtain the follow up investigations and treatments.
If not accepted for transplant
If the patient is not accepted onto the liver transplant waiting list, the patient is told and arrangements are made for follow up care.	The patient is referred to another clinic at the PAH for ongoing outpatient management or is referred back to the referring doctor. In some situation, this might involve referral to palliative care and support services.	The patient does not attend the pre-transplant clinics in the long term—as per the previous column.	Regular PTSS support is available to enable eligible regional patients to return to their home regions for follow up treatment and care.

Other possible outcomes

• The patient improves after a while and does not need a transplant, so is removed either permanently or for a short time from the liver transplant waiting list.
• The patient deteriorates and becomes too sick for transplant surgery. Inpatient care at a hospital, specialised palliative care unit or community supported palliative care at home, would be offered.
• The patient dies whilst waiting for a donor liver.

In this guide:

1. Key points
2. Referral for liver transplantation
3. Processes and help with costs
4. Step 1: Referral
5. Step 2: Assessment
6. Step 3: Case presentation
7. Step 4: Treatment pathways
8. Relocation and financial assistance
9. Brisbane accommodation information
10. Staying in Brisbane after discharge to home region
11. Long term care
12. Waiting times
13. Impact of relocation on patients and families

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