Liver transplantation is a life-saving procedure for individuals with end-stage liver disease. Not every patient is a suitable candidate for this complex surgery. Medical teams thoroughly evaluate each individual, weighing many factors to determine eligibility. This assessment aims to ensure successful outcomes and long-term survival for the recipient.
Understanding Transplant Eligibility
Liver transplant candidacy relies on established criteria. A primary tool to evaluate transplant urgency is the Model for End-Stage Liver Disease (MELD) score, or the Pediatric End-Stage Liver Disease (PELD) score for patients under 12. This numerical score, ranging from 6 to 40, is calculated using blood test results, indicating how urgently a patient may need a liver transplant within three months. A higher MELD score signifies more severe liver dysfunction and a greater probability of mortality without a transplant.
While a high MELD or PELD score indicates a patient is “sick enough” to require a transplant, it does not automatically guarantee eligibility. The MELD score helps prioritize patients on the waiting list, allocating donor livers to those with the most urgent need. Beyond liver function, transplant centers also consider a patient’s general health, including other organ systems and mental stability. These broader health requirements are important because the transplant procedure and subsequent recovery place significant demands on the entire body.
Conditions That Prevent Transplant
Certain medical conditions are absolute contraindications, meaning they prevent a patient from undergoing a liver transplant due to high risks. Severe, irreversible heart or lung disease, for instance, can make a patient too frail to withstand the rigors of surgery and recovery. These conditions might include symptomatic coronary artery disease, advanced cardiomyopathy, or chronic obstructive pulmonary disease that requires continuous oxygen.
Active, uncontrolled infections pose another significant barrier, as immunosuppressive medications required after transplant would worsen systemic infections, leading to severe complications or death. Advanced, uncontrolled cancer that has spread beyond the liver (extrahepatic malignancy) also precludes transplantation. The likelihood of cancer recurrence after transplant, negating the benefit, is considered too high.
Active substance abuse, including alcohol or illicit drugs, without a sustained period of sobriety, is an absolute contraindication. This is due to concerns about the patient’s ability to adhere to lifelong post-transplant medication and lifestyle changes. Severe, irreversible neurological damage that would prevent a patient from participating in their care or recovering from surgery also makes a transplant unfeasible.
Factors Increasing Transplant Risk
Some conditions do not outright prevent a liver transplant but increase the risk of complications or reduce long-term survival, requiring a risk-benefit analysis. Patients exhibiting significant frailty or poor functional status face higher surgical risks and a more challenging recovery. Morbid obesity also increases surgical complications, such as wound infections and cardiovascular events, and poses long-term health challenges that impact post-transplant outcomes.
Severe, uncontrolled mental health conditions may hinder a patient’s ability to adhere to post-transplant medication schedules and follow-up appointments. The absence of adequate social support is another concern, as a support system is important for navigating post-transplant care and recovery. Certain types of liver cancer, particularly those beyond standard size and number criteria (Milan criteria), complicate the decision, though they are not always an absolute contraindication. These cases involve a more complex risk assessment. Extensive portal vein thrombosis, a blood clot in the main vein supplying blood to the liver, also adds surgical complexity and risk, though it is no longer an absolute contraindication unless diffuse.
The Assessment Process
Determining whether a patient is suitable for a liver transplant involves a multi-disciplinary evaluation. A dedicated transplant team, which typically includes hepatologists, surgeons, social workers, psychiatrists, dietitians, and financial coordinators, assesses each individual. The team conducts tests, including blood work, imaging scans, and cardiac assessments, to determine if the patient is physically capable of undergoing the operation and if a transplant will improve their condition.
The decision is holistic, considering not only the severity of the liver disease but also the patient’s overall health, psychological readiness, and the presence of a reliable support system. The team evaluates the patient’s ability to understand and comply with lifelong post-transplant care requirements, including medication adherence. This thorough process ensures the best possible outcome for the patient while responsibly managing the limited availability of donor organs.