There is a strict assessment process that is used to decide who can have a liver transplant, as donated livers are scarce both in the UK and around the world.
There is a strict assessment process that decides who can have a liver transplant, as donated livers are scarce, both in the UK and worldwide.
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's expected that you have at least a 50% chance of living 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 isn't 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 symptoms represent a decline in quality of life that many people would find intolerable:
- persistent tiredness, weakness and immobility
- swelling of the abdomen, caused by a build-up of fluid (ascites), that doesn't respond to treatment
- persistent and debilitating shortness of breath
- damage to the liver that affects the brain (hepatic encephalopathy), leading to mental confusion, reduced levels of consciousness and, in the most serious of cases, coma
- persistent itchiness of the skin
Estimating survival rates
The assessment of your likely survival rate is based on:
- your age
- 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 of immunosuppressant medication
Tests will also be carried out to assess your health and your likelihood of survival. This can include examining your heart, lungs, kidneys and liver, as well as checking for any signs of liver cancer.
Who can't have a liver transplant
Even if you meet the above criteria, you may not be considered for a transplant if you have a condition that could affect the chances of success. For example, it's unlikely that you will be offered a liver transplant if you have:
- severe malnutrition and muscle wasting
- an infection – it would be necessary to wait for the infection to pass
- AIDS (the final stage of an HIV infection)
- a serious heart and/or lung condition, such as heart failure or chronic obstructive pulmonary disease (COPD)
- a serious mental health or behavioural condition that means you would be unlikely to be able to follow the medical recommendations for life after a liver transplant
- advanced liver cancer – by the time the cancer has spread beyond the liver into surrounding tissue, it's too late to cure the cancer with a transplant
Additionally, a liver transplant will not be offered if you continue to misuse alcohol or drugs. Most transplant centres only consider a person for a transplant if they haven't had alcohol or used recreational drugs for at least a few months.