Liver Transplant Evaluation and Waiting List

When liver transplantation may be considered

The goal of liver transplantation is to both prolong life and improve its quality. Patients with end-stage liver failure that cannot be managed with other treatments may be candidates for liver transplantation.

Liver transplantation is indicated for patients who have:

  • Any complication of chronic liver disease (ascites, variceal bleeding, encephalopathy)
  • Fulminant hepatic failure
  • Hepatocellular carcinoma that is small and has not spread beyond the liver
  • Inherited metabolic liver disorders
  • No absolute contraindication to liver transplantation
  • No alternative form of therapy
  • Willingness and ability to accept liver transplantation, comply with follow-up care, and cover the costs of transplant surgery and post-transplant care

If our team believes that a liver transplant is the best treatment option for you – and you wish to pursue this option – your name is added to the national United Network for Organ Sharing (UNOS) waiting list.

You will also work closely with the transplant team to complete a comprehensive informed-consent process. This process helps you, the prospective transplant recipient, make the most educated decisions about your care by ensuring that you fully understand the proposed course of treatment, including the reasons and potential risks and benefits of the procedures, evaluations, and studies you will likely undergo during the transplant process.

About the waiting list

The liver transplant waiting list is a computer list maintained by the United Network for Organ Sharing, which coordinates efforts among donor hospitals and transplant centers nationwide to allocate donated organs for transplantation.

The wait time varies for liver transplant, depending upon organ availability and the severity of your illness. During this time, you will be seen in the UT Southwestern Medical Center Transplant Clinic and will need to have regular lab work to maintain your position on the UNOS waiting list.

There is no way to know when a donor liver will become available. From the time you are placed on the waiting list, you will need to be available by phone at all times so that the transplant coordinator can reach you when an organ becomes available. Transplant surgery usually occurs within six to 12 hours of initial contact.

It is critical that you contact your transplant team with any changes in your phone number, address, or insurance coverage.

It is also important that you keep the transplant team updated about your overall health after you’ve been accepted as a transplant candidate. If you develop a serious infection or your health otherwise worsens, ask your doctor to notify the transplant office, as we may need to upgrade your priority on the waiting list. You also should notify us if you are admitted to another hospital.

Because the waiting period can be stressful, we invite patients and families to take part in a support group led by one of our transplant social workers. The group is open to patients being evaluated for liver transplantation, those waiting for transplant, and those who have received liver transplants. We offer patients and families a caring environment in which to share experiences, coping strategies, and information related to liver transplantation.

How healthy donor livers are prioritized and allocated

To ensure that all patients in need of a liver transplant have equitable access to available donor organs, we use patient-evaluation tools developed by the UNOS/Organ Procurement and Transplantation Network:

  • Model for End-Stage Liver Disease (MELD) – Patients 12 years old and older
  • Pediatric End-Stage Liver Disease (PELD) – Patients younger than 12 years old

MELD and PELD scores help us prioritize and allocate donor livers to the patients who need them most. The higher a patient’s MELD or PELD score, the sicker – and higher up the transplant waiting list – he or she is.

These evidence-based guidelines take into account factors such as blood-clotting time and levels of bilirubin, creatinine, and sodium; and help us assess the relative disease severity and risk of death in every patient with end-stage liver disease.

Unlike other transplanted organs, livers are matched only for blood type and size. They don’t require special tissue-typing to determine which liver donor makes the best match.