Helping your body digest food, clear wastes, and store energy, your liver is the largest organ inside your body. Without a functioning liver, you cannot live. If medical treatment cannot keep a damaged liver working, your only option is a liver transplant.
If your liver no longer functions to the level it needs to in order to sustain your life, a liver transplant is your only option. To be considered for a liver transplant, you must meet certain criteria:
To meet liver transplant criteria, you must have a liver that is not functioning properly and is beyond the stage that it can be repaired. When your liver is damaged, it grows new tissue to heal itself. When the damage is severe and results in scarring (fibrosis) of the liver, it’s called cirrhosis. Cirrhosis can lead to:
- liver failure
- portal hypertension, where the scarring inhibits blood flow causing pressure to increase in the vein that brings blood to the liver (portal vein)
- hepatocellular carcinoma, or primary liver cancer
Before you’re considered a viable candidate for liver transplant, you will need a pretransplant evaluation, which may include tests such as:
- assessment by a hepatologist (liver specialist)
- assessment by a transplant surgeon
- lab tests, such as blood work, X-rays, and imaging tests like CT or MRI scans
- endoscopy to examine your digestive tract
- colonoscopy to examine your large intestine
- heart and stress tests, such as an electrocardiogram (EKG)
- emotional evaluation to determine your ability to handle stress and follow medical instructions
Financal and insurance evaluation
You will meet with a financial specialist to make you aware of the needed resources and the extent of your insurance coverage for the procedures, medication, and other expenses of a liver transplant.
After your evaluation has been completed, a committee — made up of hepatologists, surgeons, transplant nurse coordinators, a psychosocial team, and the financial counselor — will review the findings from the tests and evaluations. They will decide if a transplant is right for you. The committee’s response is typically one of three decisions:
- No. The risks outweigh the benefits. You are too ill and there is fear that you cannot survive the surgery.
- No. You are too healthy and will be set up for monitoring for signs of liver failure. If your liver gets worse, you will be reevaluated.
- Yes. You are a viable candidate and will be put on the waiting list.
When you’re put on the waiting list, you’re given a MELD score (model of end-stage liver disease) based on the findings of your blood tests. Children are given a PELD (pediatric end-stage liver disease) score. This computer-calculated score puts those most in need higher on the list to get a liver. There’s no way to influence this list by any means other than your degree of need.
While on the waiting list, you’ll see your doctor on a regular basis. Not only do you want to be in good health for the operation, but also, your doctor will update your MELD or PELD score. According to the Gift of Life Donor Program, the average median waiting time is 11 months for a liver.
When a donor is located for you, you will be contacted to get to the hospital. Prepping for the operation (e.g., anesthesia, and heart and blood pressure monitoring) will take about two hours. The transplant operation usually takes six to eight hours.
Following surgery, you will wake up in the intensive care unit (ICU) where you will be monitored until your doctors are comfortable moving you to an area of the hospital where you will be under the care of your doctors and nurses specializing in transplant patients. Barring complications — such as infection, blood clots in your liver, or poor liver function — you will leave the hospital in two to three weeks.
Once home, you will continue to undergo tests so your doctors can monitor your health and that of your new liver. They are primarily concerned about:
- acute rejection
- the return of liver disease
- medical complications, such as high blood pressure, infection, diabetes, and high cholesterol
There are many positive stories about liver transplant recipients living long and happy lives. A recent study indicates an approximately 75 percent chance. Your chances might be different because that number represents all liver transplant recipients, including older adults, the very young, those with advanced disease, and those with less severe liver problems.
You can donate a portion of your liver for a transplant. After your donation, your liver cells will regenerate and the organ will grow back to close to its original size, both for you and the recipient. To be a living donor, you must meet the following requirements:
- donation is completely voluntary
- good physical and mental health
- between the ages of 18 and 60
- body mass index (BMI) less than 35
- compatible blood type with the recipient
- no significant organ diseases such as heart disease or kidney disease
- no ongoing malignancy (cancer)
- no HIV/AIDS
- no hepatitis
- no active or chronic infections
- no active substance abuse
For many people, liver transplant is a necessary, lifesaving procedure. With more people needing livers than there are livers available, potential recipients are put on a waiting list. If you want to be a donor by having part of your liver removed for a transplant recipient, your liver will regenerate.