Liver transplants are done in people who are in the final stages of liver failure, which can be either acute or chronic. Acute liver failure happens quickly, within weeks, whereas chronic liver failure happens over months or even years. The most common cause of chronic liver failure is cirrhosis.1
The history of liver transplants
Transplant medicine began in the 1950s. Although it took a few years before liver transplantation started to result in patients living longer, the field has made great strides. Thanks to advancements in surgical techniques, improvements in critical care, and the development of better immunosuppressive drugs, it is now an established and successful form of therapy. However, there often aren’t enough livers as there are people who need them.
Organizations that manage liver transplants
The process of organ donation depends on your location. The Eurotransplant Foundation based in Leiden (the Netherlands) serves the following countries: Austria, Belgium, Croatia, Germany, Hungary, Luxembourg, the Netherlands and Slovenia.3 In the United States, donor livers are allocated based on the 11 regions of the United Network of Organ Sharing (UNOS).4 In the United Kingdom, organ matching and allocation is managed by NHS Blood and Transplant*.5 In Australia and New Zealand, there is ANZLITR, the Australian & New Zealand Liver and Intestinal Transplant Registry.6
If you live outside these areas, ask your healthcare team about your local organ transplant organization.
Liver transplant criteria: who qualifies for the procedure?
Doctors will use the results of your liver function tests and several other factors to assess the severity of your illness, how urgently you need a transplant and how high you should be on the liver transplant waiting list. Patients on the waiting list are often prioritized using scoring systems such as the Model for End-Stage Liver Disease (MELD).1
When you get towards the top of the waiting list, your local liver database will be assessed to find a donor liver that matches your blood type. If there is a liver available that matches both you and another person on the list, the amount of time you have already spent waiting will be taken into account.1
Before you undergo the transplant surgery, you will also have to undergo a number of assessments to make sure you are healthy enough to both survive the surgery and tolerate the treatments you will have to take for the rest of your life after the surgery.1
For example, you may have examinations to determine the health of your heart and cardiovascular system, and a general health examination to check for any conditions that might impact the success of the transplant.1
Your eligibility can depend on many factors. Here are some examples: 7
- Health problems, such as the presence of some cancers
- Your continued abstinence from alcohol and illegal drugs
- Your ability to listen to and implement the advice of your healthcare professionals
Where do donor livers come from
In the majority of cases, donor livers come from people who have died. However, in some cases, living donors can be found. The donor can be a friend, relative or stranger, as long as they match your tissue type.8 They can donate a portion of their liver to you, and because of the liver’s incredible ability to regenerate, this means that it will grow back to normal size in both your donor and you1.
Life after the transplant
According to the European Liver transplant registry, one-year post transplant survival rates are over 83%, 5-year survival rates over 71%, and 10-year survival rates over 61%.9
Follow-up care may include regular check ups, medications that suppress your immune system, diet changes, exercise, and avoidance of alcohol, amongst other things.1
Liver transplants are done in people who are in the final stages of liver failure.
- Liver Transplant. Mayo Clinic. Jul 2020. Available at: https://www.mayoclinic.org/tests-procedures/liver-transplant/about/pac-20384842 (Last accessed: Oct 2020)
- Song AT, Avelino-Silva VI, Pecora RA, Pugliese V, D’Albuquerque LA, Abdala E. Liver transplantation: fifty years of experience. World J Gastroenterol. 2014;20(18):5363-5374. doi:10.3748/wjg.v20.i18.5363
- Eurotransplant. Cooperating saves lives. Available at: https://www.eurotransplant.org/about-eurotransplant/cooperating-saves-lives/ (Last accessed Sept 2020)
- Kim PT, Testa G. Living donor liver transplantation in the USA. Hepatobiliary Surg Nutr. 2016;5(2):133-140. doi:10.3978/j.issn.2304-3881.2015.06.01
- Transplantation Services. NHS Blood and Transplant. Available at: https://www.nhsbt.nhs.uk/what-we-do/transplantation-services/ [Last accessed Oct 2020)
- ANZLITR. Australian & New Zealand Liver and Intestinal Transplant Registry. Available at: https://www.anzlitr.org/ (Last accessed Oct 2020)
- Lucey MR, et al. Minimal criteria for placement of adults on the liver transplant waiting list: A report of a national conference organized by the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases. Liver Transplantation and Surgery. 2003;3(6):628-637Huizen J, Murrell D. How long will I survive after a liver transplant? Medical News Today. May 2018. Available at: https://www.medicalnewstoday.com/articles/321754 (Last accessed Oct 2020)
- Huizen J, Murrell D. How long will I survive after a liver transplant? Medical News Today. May 2018. Available at: https://www.medicalnewstoday.com/articles/321754 (Last accessed Oct 2020)
- Adam R, et al. 2018 Annual Report of the European Liver Transplant Registry (ELTR) – 50-year evolution of liver transplantation. Transplant International 2018; 31: 1293–1317
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