How does the offering system work?

Learn how livers from deceased donors are offered to patients

Key points

  • It is important for donated organs to go to a patient who will benefit from it
  • Patients are prioritised based on many different factors
  • How long you have been waiting for an organ is also taken into account
  • The organ offer will first go to your transplant team. If they feel it is suitable for you, they will get in touch

How are livers offered?

Every donated liver is a precious gift, and it is important that the organ goes to a patient who will benefit from it.

Once a potential deceased donor is identified, blood tests are taken to check the donor’s blood group and to check the function of their organs. Other blood tests are taken to see whether the donor has any infections.

This information is the passed to NHS Blood and Transplant and a nationally-agreed computer programme checks the national transplant waiting list for suitable patients.

Patients are prioritised for the liver based on:

  • Blood group
  • The severity of their liver disease and how likely they are to benefit from a liver transplant
  • How long they have been in the waiting list

A national committee agrees the way that deceased donor livers are offered, with advice from NHS Blood and Transplant. The national committee agrees on how patients should be prioritised and how the computer programme should run.

What happens if you are offered a liver?

If the liver is being offered to you, then NHS Blood and Transplant will contact your transplant centre to inform them about the offer. The transplant team at your centre will then examine the donor information and your medical history to decide if the offered liver is suitable for you. Not all organs are suitable for all patients. 

If your transplant centre thinks the liver offer is suitable for you, you will be contacted by telephone.

In the meantime, specialist surgeons (the National Organ Retrieval Service) will travel to the donor’s hospital to remove the donor’s organs. Donated organs are flushed with a special fluid to help preserve them, then packed in a box with fluid and ice. Sometimes the liver can be placed on a special machine to pump blood through it after is has been removed from the donor.

Can offers be declined? 

Yes. If you feel the organ has an unacceptably high chance of failure or other major problems, you can decline the offer and wait for another organ.

Your transplant team can also decline the offer if they feel the organ is not suitable for you.

Your transplant team may want to talk to you over the telephone about the organ’s suitability. Or they may prefer to speak directly to you about any issues when you come in to the transplant centre. Sometimes, the final decision about whether an organ is suitable for you can only be made once the organ has been looked at in the donor’s hospital.

If the organ offer is declined, it will usually be offered to another patient.

Learn more about accepting or declining an offer

National criteria for offering livers

All transplant teams in the UK must follow national criteria for selecting patients suitable for a liver transplant.

View the national criteria for offering livers (POL196)

More information

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