Liver transplant - Who can use a liver transplant

There is a strict assessment process that decides who can have a liver transplant, as donated livers are scarce both in England and around the world.

Under UK regulations you are usually only considered a suitable candidate for a liver transplant if you meet two conditions:

• without a liver transplant, it is highly likely that your expected lifespan would be shorter than normal, or your quality of life is so poor as to be intolerable 
• it is expected that you have at least a 50% chance of surviving for at least five years after the transplant with an acceptable quality of life

Transplant centres use a scoring system to calculate the risk of a person dying if a transplant is not performed.

In the UK, the system is known as the United Kingdom Model for End-Stage Liver Disease (UKELD). This is based on the result of a series of four blood tests that create an average score. The higher your UKELD score and your risk of death, the higher up the waiting list you will be.

Assessing quality of life

Assessing your quality of life can be a subjective process. However, the following signs and symptoms represent a decline in quality of life that many people would find intolerable:

• swelling of the abdomen caused by a build-up of fluid (ascites) that fails to respond to treatment
• persistent and debilitating shortness of breath
• damage to the liver that affects the normal workings of the brain (hepatic encephalopathy), resulting in mental confusion, reduced levels of consciousness and, in the most serious of cases, coma
• persistent itchiness of the skin that fails to respond to treatment (for reasons that are still unclear, itchy skin is a common symptom of liver disease)
• persistent liver pain that cannot be controlled by treatment

Estimating survival rates

The assessment of your likely survival rate is based on your individual circumstances and associated factors, such as:

• your age (although transplants have been successful in people aged over 70)
• whether you have another serious health condition, such as heart disease
• how likely a donated liver would remain healthy after the transplant
• your ability to cope (physically and mentally) with the effects of surgery and the side effects associated with immunosuppressant medication

A number of tests will also be carried out to assess your health and your likelihood of survival.

These tests can include extensive investigations of your heart, lungs, kidneys and liver, as well as checking for any signs of liver cancer.

Ruling out a liver transplant

It is unlikely that you will be offered a liver transplant if you have two or more of the following conditions:

• kidney failure – where the kidneys have lost most or all of their function
• extensive weight loss because of poor health and malnutrition
• an active hepatitis B infection that is not responding to medication
• a blood clot in one of the main blood vessels near the liver

A liver transplant will not be offered if you have any of the following conditions:

• AIDS (the final stage of HIV infection)
• irreversible brain damage
• an infection – it would be necessary to wait for the infection to pass
• multiple organ failure that would not be helped by a liver transplant
• cancer in another part of the body (with the exception of skin cancer)
• a serious heart and/or lung condition, such as heart failure or chronic obstructive pulmonary disease (COPD)
• a serious mental health or behavioural condition, such as psychosis or bipolar disorder, which means you would be unlikely to be able to comply with the medical recommendations regarding life after a liver transplant
• advanced liver cancer – by the time the cancer has spread beyond the liver into surrounding tissue, it is too late to cure the cancer with a transplant

Additionally, a liver transplant will also not be offered if you are:

• abusing alcohol – most transplant centres only consider a person for transplant if they have not had alcohol for at least three months
• abusing drugs – most transplant centres would only consider a person for transplant if they attend a drug rehabilitation course and remain free from drugs for at least six months (some transplant centres will accept people who are currently taking the heroin substitute methadone)