How do doctors decide if you need a liver transplant?

This is a complex decision and involves lots of specialists

Key points

You will need tests to see if you’re fit enough to cope with liver transplant surgery
Your case is then discussed by a team of specialists
The decision-making is complex, taking into account many factors
A clinical score (UKELD score) is used to decide who might benefit from a liver transplant

Liver transplant assessment test

If you develop decompensated end-stage liver disease, your consultant may refer you for an assessment at a liver transplant centre. This may be as an inpatient or an outpatient, depending on the centre. The assessment will involve blood tests, CT/ MRI scans and fitness tests.

Learn more about liver transplant tests

Decision-making process

Your case will be discussed in a multidisciplinary meeting where a recommendation will be made. This brings together surgeons, hepatologists (liver doctors), anaesthetists, intensive care specialists, liver transplant coordinators, a dietician, social worker and in some cases a psychiatrist. These specialists will assess the findings of your assessment tests.

The decision-making is often complex and takes into account your clinical condition, family support and potential for recovery without a liver transplant.

The decision to offer a place on the national waiting list is based on both the benefits that a transplant can bring and the risks associated with this treatment.

Clinical score

A clinical score (UKELD score) is used to decide who might benefit from a liver transplant for most patients. There are some patients who have liver diseases where a UKELD score is not helpful.

How is the UKELD score calculated?

What score do you need to go on the waiting list for a liver transplant?

What does minimal listing criteria mean?

What else is taken into account?

What if you don’t meet the minimal listing criteria?

Guidance for patients with hepatocellular cancer

If you have hepatocellular cancer, you can be listed for a transplant if your tumours meet the relevant national listing criteria. These are based on the number and size of tumours and the result of a blood test called alpha-feto protein (AFP). Unfortunately, if your disease has progressed beyond these criteria or if your cancer has spread into large blood vessels or beyond the liver, liver transplant is not an option, as the operation would not be curative and in some cases result in the disease worsening.

What happens next?

You will be informed of the decision outcome

Going on the waiting list for a transplant

If the recommendation is for you to be placed on the waiting list for a transplant, you will be asked confirm your decision.

You may be asked to attend a specialist consenting clinic to ensure there is a full understanding of the process and the procedure and the consent to proceed is signed. You will be reviewed on the waiting list at regular intervals.

In some rare cases you may be assessed and referred to another centre, usually due to the availability of specific expertise.

Learn more about going on the transplant waiting list

Getting a second opinion