Because there are over 15,000 people on the waiting list for a liver, according to the United Network for Organ Sharing (UNOS), and many more not listed but also in need, there aren't enough donated livers for everyone. Medical centers that do liver transplants have requirements anyone desiring a liver transplant must meet. One method for deciding who gets a liver transplant is the use of MELD (Model for Liver End-Stage Disease), a scoring system whereby people are assigned a spot on the waiting list, but most centers have additional requirements.
Severity of Disease
Over the last decade, liver allocation through UNOS has changed significantly with the advent of the MELD scoring system designed by the Mayo Clinic. While the system is not perfect, calculating a person's MELD score from the results of three different blood tests that measure how liver failure is affecting the body, then comparing it to the MELD scores of others, helps ensure that sicker people within a region get livers first. Blood types of donors and recipients must match, and centers must also consider the body size and the presence of hepatitis C in a donor organ; so the person with the top score in a region doesn't always get the next liver.
Compliance
Being on the transplant list requires absolute adherence to certain regulations, and not following the rules can get you taken off a center's list. Rules include complete abstinence from alcohol and any drugs not prescribed by the center; many centers also require a six-month abstinence period plus attendance at an approved drug rehabilitation program, according to a 2001 article published in Transplantation.
Ability to Withstand Surgery
Liver transplant is major surgery. Candidates for transplant must be able to withstand the surgery, or the patient and the donor liver may be lost. Most centers do rigorous cardiac and pulmonary testing, as well as numerous blood and imaging studies, to make sure the recipient is healthy enough to survive transplant.
Mental and Emotional Stability
A transplant candidate also has to be mentally able to handle the complex medicine regimens required after transplant, and must commit to follow up with the center or an appointed medical clinic to ensure everything possible is done to preserve the liver given by the donor's family, according to University of Michigan guidelines. A social service consult is also required by many centers to assess the patient's and family's emotional ability to undergo a long, rigorous and often difficult surgery and aftermath. Centers understand that people needing a transplant aren't at their best emotionally, but expect to see a basic ability to cope with the aftermath of surgery.
Active Cancer Outside the Liver
While a previous history of cancer won't always keep people off the transplant list, active cancer in an organ other than the liver may, according to liver specialist Dr. Melissa Palmer. Antirejection drugs taken after transplant surgery are immunosuppressants and may encourage the growth of abnormal cancer cells.
