Why are some people turned down for a liver transplant

August 12, 2015
The decisions of a liver transplant program can sometimes seem unfair or even arbitrary, especially when a loved one is turned down for a liver transplant. While everyone in need of a transplant deserves an opportunity to be evaluated, not everyone can be placed on the waiting list.

Over 6,000 liver transplants are performed in the US each year. There are more than12,000 people on the waiting list, and over 2,000 people die each year while waiting because of a substantial scarcity of organs. Each of the 143 transplant programs in the US has a committee of liver transplant experts that meets regularly to discuss potential candidates. The goal of this committee is to ensure that life-saving organs are distributed justly to patients who are able to manage the complexities of life after a liver transplant.

Patients are eligible for a liver transplant if they have complications from end-stage liver disease, certain types of liver cancer or acute (sudden) liver failure. Liver transplant experts can also tell when someone is in need of a liver transplant by calculating a score called the “MELD”, which stands for “Model for End-stage Liver Disease”. The MELD score objectively estimates the severity of someone’s liver disease using 3 common blood tests that measure liver and kidney function: bilirubin, INR and creatinine. It can be calculated using one of several online calculators (see an example here). Higher scores indicate a more urgent need for liver transplantation, while low scores (generally less than 15) indicate that a person may not benefit from a transplant.

To be eligible for a liver transplant, it isn’t enough to have complications from end-stage liver disease or a high MELD score. Patients also need to be healthy enough to withstand a complex and risky surgery. Certain factors such as morbid obesity, prior abdominal surgery, major blood clots or general physical weakness can significantly complicate transplant surgery and may exclude a patient from listing. Patients must demonstrate a willingness and ability to adhere to a complex medical regimen that includes frequent doctor visits, multiple medications, and repeated blood tests and scans. Transplant candidates must have adequate caregiver support before and after transplantation and be free of any social or financial barriers to transplantation. Patients with untreated alcohol or other substance abuse disorders or untreated psychiatric illnesses are not eligible for transplantation. Patients who meet all of these requirements may sometimes be too sick or even too well for a liver transplant and are not placed on the waiting list.

It’s not easy for a family member or loved one to accept an unfavorable decision from the transplant committee, but the decision to turn someone down for liver transplantation is never made lightly. The selection of appropriate transplant candidates is based on multiple objective factors and discussed among many experts who follow a rigorous evaluation process. Sometimes patients can be reconsidered after addressing the committee’s concerns. Patients who are ultimately declined at one transplant center are permitted to seek a second opinion at another center, which may occasionally decide to place the patient on the waiting list.

For more information from the Swedish Liver Transplant program, click here or call 1-800-99ORGAN (1-800-996-7426).
Topics: Services