A liver transplant may be an option if you have advanced liver disease, cirrhosis of the liver with complications related to liver disease, liver failure, some types of liver cancer and once other treatments are no longer working for you. Not everyone with liver disease is a candidate for liver transplant. Evaluation is key and an important first step.
The liver transplant qualification process helps make sure that transplant surgery is safe, appropriate and likely to provide you with long-term benefits.
Who is eligible for a liver transplant?
A combination of medical, physical and personal factors determines whether you are eligible for a liver transplant. The transplant team evaluates each person individually to decide whether a transplant is the right option. It’s important to be sure that the transplant offers a good chance for meaningful benefits.
In general, most people who are candidates for liver transplant have liver disease that is severe enough to affect their quality of life or survival but who are healthy enough to undergo major surgery and manage the long-term follow-up care that’s needed.
General liver transplant eligibility criteria
Eligibility varies from person to person. These are some of the factors transplant teams usually use to help guide the evaluation process:
- The condition that needs treatment: Transplantation must be a proven treatment for your condition.
- How severe your liver disease is: To qualify for a transplant, you must have managed your disease well but reached a point where you are no longer responding to treatment or no other therapy is available.
- Overall health: You need to be able to be healthy enough (even though you are ill) to tolerate surgery, recovery and follow-up medical care. Your heart and lungs need to be healthy enough to support you during recovery and afterward.
- Age and body composition: Your age, weight (both overweight and underweight) and other medical conditions are considerations. These are evaluated individually. There are no strict age cutoffs. BMI cutoffs vary and depend on your individual medical situation.
- Emotional readiness: You need to understand the transplant process and the commitment you need to make to lifelong care.
- Lifestyle changes: You need to have stopped using alcohol, tobacco and recreational drugs.
- Medication and follow-up: You need to be willing and able to take your medications as prescribed and attend regular appointments.
- Adequate support system: You’ve identified a caregiver to help you before and after transplant.
- Financial resources: You have insurance coverage and benefits to cover the expense of transplant surgery and your lifetime medications and you are prepared to pay the costs of deductibles and co-pays.
Liver transplant referral process
You will probably be referred for liver transplant evaluation by a liver specialist, gastroenterologist or primary care provider.
Once the transplant team receives your referral, they review your medical records and decide on next steps. If you move forward in the process at that point, the team schedules you for a comprehensive transplant evaluation.
Evaluation for liver transplant
The liver transplant evaluation is thorough and many specialists are involved.
Your evaluation may include:
- Review of your liver disease history, treatments you’ve tried and how they’ve worked
- Blood and urine tests
- Imaging tests like X-rays, computed tomography (CT) scan, magnetic resonance imaging (MRI) and ultrasound to look at and evaluate your liver and other organs
- Electrocardiogram (EKG), stress test and other heart testing
- Pulmonary function test (PFT) to measure lung function and check for breathing problems
- Arterial blood gases to check oxygen levels
- Walking test to evaluate your physical condition
- Bone density scan (DEXA scan)
- Testing for infectious diseases such as tuberculosis (TB), HIV, syphilis, coccidioidomycosis (Valley fever), hepatitis B and C and other viruses
- Dental X-ray to check for infections in the mouth
- Routine health maintenance testing such as mammogram and pap test for females, prostate specific antigen (PSA) for males and colonoscopy and esophagogastroduodenoscopy (EGD) if recommended
- Financial counseling to discuss transplant costs, insurance coverage and out-of-pocket expenses
- A psychosocial evaluation that checks to see if you are prepared for liver transplant and if you have a support system and caregiving plans in place
Choosing a caregiver
Before you are approved for transplant, you will need to name a caregiver who will be your advocate and support person before and after your liver transplant. This person will need to be available to help you around the clock for about a month after your surgery.
Caregivers need to be with you at your educational sessions so they understand:
- What medications you take, why you take them and when you need to take them
- Signs and symptoms of rejection
- Your dietary needs after your transplant
- Who to contact for help after you’re discharged from the hospital
- When and where follow-up visits will be scheduled
Caregivers also help with:
- Transportation to and from medical appointments
- Picking up medications from a pharmacy
- Contacting the transplant center or doctor if issues come up
- Household duties like meal preparation, cleaning, shopping and errands
Selection for liver transplant
After your evaluation steps are finished, a multidisciplinary transplant committee reviews the findings and decides whether to recommend a liver transplant. This team uses selection criteria and United Network for Organ Sharing (UNOS) regulations.
They may decide:
- You are approved for transplant: You meet the selection criteria and your name is added to the UNOS wait list once insurance authorization is in place, usually in three to 14 days.
- You are not approved but your case may be resubmitted for review: You may need additional testing, consultation or to meet other requirements.
- You are not a candidate for transplant: You do not meet selection criteria to be placed on the liver transplant waitlist.
When you may not qualify
In some cases, you may not qualify for liver transplant right away or at all. The transplant committee does not recommend liver transplant if they don’t think it would be safe or effective for you.
Factors that may affect your eligibility include:
- Uncontrolled medical conditions that make surgery riskier for you
- Advanced heart disease or lung disease
- Having infections that can’t be treated
- Ongoing alcohol or tobacco or recreational drug use, including marijuana.
- Uncontrolled or untreated psychiatric conditions
- Not being able to take medication as directed or to follow plans for care and monitoring after surgery
- Not being able to follow the recommendations outlined by the transplant care team
If you don’t qualify for liver transplant, you may be able to be evaluated again if medical treatment or lifestyle changes improve your likelihood of eligibility.
Next steps after qualification
If you qualify for a liver transplant, you are placed on the national transplant waiting list, managed through the United Network for Organ Sharing (UNOS).
Your placement on the list is based on your Model for End-Stage Liver Disease (MELD) score. The score ranges from 6 (healthiest) to 40 (sickest) and is based on certain lab tests. People who are the sickest are placed higher on the list.
While you’re waiting, the transplant team monitors you closely. Your place on the list can change depending on your laboratory tests and your MELD score. You could spend days to years on the list. You are not guaranteed a liver transplant because you are on the list. Some people that are on the list may become too sick to receive a liver transplant. While others may be removed from the transplant list due to specific and certain critical situations.
During this time, the team provides education and helps you prepare and understand what to expect before and after your surgery. Learn more about preparing for a liver transplant.
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