A liver transplant is a life-saving procedure recommended for patients with end-stage liver disease or acute liver failure. However, not all patients are inherently eligible for transplantation. Liver specialists follow strict clinical criteria and evaluate various eligibility factors before placing a patient on a transplant list.
Medical Criteria for Liver Transplant
The primary criteria for a liver transplant focus on the severity of liver disease, the urgency of the transplant, and the likelihood of post-operative success. Most patients are assessed using the Model for End-Stage Liver Disease (MELD) score, which considers serum bilirubin, creatinine, and INR levels. A higher MELD score indicates greater urgency and usually qualifies a patient for earlier transplant consideration. Common conditions that qualify include cirrhosis, alcoholic liver disease, non-alcoholic steatohepatitis (NASH), chronic hepatitis B or C, and certain metabolic disorders. Acute liver failure, especially when caused by paracetamol overdose or viral hepatitis, can also warrant immediate evaluation by a liver specialist for urgent transplantation.
Apart from the MELD score, liver specialists also look for signs of liver decompensation, such as jaundice, ascites, hepatic encephalopathy, or variceal bleeding. Repeated hospitalisations due to these complications may signal the need for transplantation. In cases of liver cancer (typically hepatocellular carcinoma), patients are assessed based on tumour size and number using the Milan Criteria. Only those within these parameters, typically one lesion smaller than 5 cm or up to three lesions each smaller than 3 cm, are usually considered for liver transplant to reduce the risk of recurrence.
Eligibility Requirements for Liver Transplant
Meeting the clinical criteria does not automatically ensure eligibility for a liver transplant. Specialists must also evaluate a patient’s overall physical and psychological health to determine suitability. Candidates must be free from active infections, advanced cardiac or pulmonary disease, and metastatic cancers. They are also required to have acceptable kidney function and the ability to withstand major surgery. Mental health stability is essential, as post-transplant care demands strict compliance with medications and follow-up visits.
Substance abuse history plays a significant role in transplant eligibility. Patients with alcoholic liver disease or drug-induced liver failure must demonstrate sustained abstinence—often verified through six months of sobriety and regular counselling—before they are considered eligible. Additionally, liver specialists evaluate the presence of a reliable social support system. Patients must have caregivers or family members who can assist with post-operative care, transport, and emotional support. Non-compliance with medical advice or poor social support may result in disqualification.
Financial preparedness is another eligibility requirement. Liver transplant surgery, ongoing medication, and follow-up care are costly. Patients in many countries are expected to show proof of financial coverage through insurance or personal funds. While some hospitals may offer assistance or subsidies, the responsibility to maintain continuity of care remains with the patient.
When a Liver Specialist May Defer or Deny a Transplant
Even when medical necessity is evident, a liver specialist may defer transplant listing if reversible conditions exist that should first be addressed. This condition includes infections, untreated cardiovascular issues, or severe malnutrition. The transplant team may also deny listing if the patient is unlikely to survive surgery or follow the long-term regimen necessary for graft survival. Patients with ongoing substance abuse, poor treatment adherence, or lack of psychosocial support are considered high-risk and are often not approved.
Conclusion
A liver transplant is a complex decision that involves more than just medical urgency. Liver specialists evaluate both clinical indicators and the patient’s general capacity to receive and maintain post-transplant treatment. Meeting eligibility requirements entails demonstrating medical necessity, emotional and psychological readiness, lifestyle compliance, and enough support. Early consultation with a liver specialist is critical for knowing one’s status and improving the chances of approval when the time comes.
Visit National University Hospital (NUH) and let us help you understand your options for liver transplant eligibility and preparation.
