Being placed on the waiting list
If you have chronic liver failure, your doctor may refer you to a transplant center to undergo evaluation for liver transplant. The transplant center team conducts a wide variety of tests and procedures to determine whether to place your name on the waiting list for a new liver.
Tests, procedures and consultations you may undergo include:
- Laboratory tests, including blood and urine tests to assess the health of your organs, including your liver
- Imaging tests, such as an ultrasound of your liver
- Heart tests to determine the health of your cardiovascular system
- A general health exam, including routine cancer screening tests, to evaluate your overall health
- Nutrition counseling with dietitians who assess your nutritional status and make recommendations regarding nutritional intake before and after transplant
- Psychological evaluation to determine whether you fully understand the risks of a liver transplant
- Meetings with social workers who assess your support network to determine whether you have friends or family to help care for you after transplant
- Addiction counseling to help people with alcohol, drug or tobacco addictions to quit
- Financial counseling to help you understand the cost of a transplant and post-transplant care and to determine what costs are covered by insurance
Once these tests and consultations are completed, the transplant center's selection committee meets to discuss your case. It determines whether a liver transplant is the best treatment for you and whether you're healthy enough to undergo a transplant. If the answer to both questions is yes, then you're placed on the transplant waiting list.
Determining your position on the waiting list
Doctors use results of liver function tests and other factors to determine your prognosis and your place on the transplant waiting list. Your prognosis is sometimes called your Model for End-Stage Liver Disease (MELD) score. The higher your MELD score, the more dire your situation. Organs are allocated based on MELD scores. People with higher MELD scores generally are offered donated livers first. MELD scores range from 6 to 40.
Some liver conditions, such as liver cancer, may not result in a person getting a high MELD score. The transplant center can request additional MELD points for people with specific diseases if they meet defined criteria.
Waiting for a new liver
Your wait for a donor liver could be days, or it could be months. Or a donor liver that's a good match for you might not become available.
As you wait for a new liver, your doctor will treat the complications of your liver failure to make you as comfortable as possible. Complications of end-stage liver failure are serious, and you may be frequently hospitalized. If your liver deteriorates, your MELD score is updated.
Living liver donors
A small percentage of liver transplants are completed each year using a portion of a liver from a living donor. If you have a family member or friend who is willing to donate part of his or her liver to you, talk to your transplant team about this option.
Living-donor transplants have good results, just like transplants using livers from deceased donors. But fewer living transplants are performed because of restrictions on the donor's age, size and health that make finding a good match difficult. The surgery carries significant risks for the donor. Your transplant team can discuss the risks with you and the potential donor.
Feb. 10, 2015
- Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 9th ed. Philadelphia, Pa.: Saunders; 2010. http://www.mdconsult.com/book/player/linkTo?type=bookHome&isbn=978-1-4160-6189-2&eid=4-u1.0-B978-1-4160-6189-2..X0001-7--TOP&uniq=200844987-3. Accessed May 28, 2014.
- Liver transplant. American Liver Foundation. http://www.liverfoundation.org/abouttheliver/info/transplant/. Accessed May 28, 2014.
- What I need to know about liver transplantation. National Institute for Diabetes and Digestive and Kidney Diseases. http://digestive.niddk.nih.gov/ddiseases/pubs/livertransplant_ez/. Accessed May 28, 2014.
- Questions & answers for transplant candidates about MELD and PELD. United Network for Organ Sharing. http://www.unos.org/docs/MELD_PELD. Accessed May 28, 2014.
- Liver Kaplan-Meier patient survival rates for transplants performed: 1997-2004. Organ Procurement and Transplantation Network. http://optn.transplant.hrsa.gov/latestData/rptStrat.asp. Accessed May 28, 2014.
- Keaveny AP (expert opinion). Mayo Clinic, Jacksonville, Fla. July 5, 2014.