{"id":2996,"date":"2026-09-15T13:58:12","date_gmt":"2026-09-15T13:58:12","guid":{"rendered":"https:\/\/bookinghospital.org\/?p=2996"},"modified":"2026-09-15T14:02:59","modified_gmt":"2026-09-15T14:02:59","slug":"liver-transplant-who-can-have-one","status":"publish","type":"post","link":"https:\/\/bookinghospital.org\/az\/liver-transplant-who-can-have-one\/","title":{"rendered":"Who Can Have a Liver Transplant? What the Guidelines Say"},"content":{"rendered":"<div data-elementor-type=\"wp-post\" data-elementor-id=\"2996\" class=\"elementor elementor-2996\">\n\t\t\t\t<div class=\"elementor-element elementor-element-fd52c50 e-con-full e-flex e-con e-parent\" data-id=\"fd52c50\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-decbcf2 elementor-widget elementor-widget-html\" data-id=\"decbcf2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div id=\"bh\">\n\n<section class=\"hero\">\n  <div class=\"in\">\n    <p class=\"eyebrow\">Liver transplantation \u00b7 Who can receive<\/p>\n    <h1>Told you are too sick, too old or too heavy for a liver transplant?<\/h1>\n    <p class=\"lead\">Many patients are turned away for reasons that the latest international\n       guidelines no longer accept. Here is what the European and American liver societies\n       actually recommend \u2014 and what genuinely rules a patient out.<\/p>\n    <p class=\"meta\">Based on the <b style=\"color:#fff\">EASL 2024<\/b> and\n       <b style=\"color:#fff\">AASLD\/AST 2025<\/b> liver transplantation guidelines<\/p>\n  <\/div>\n<\/section>\n\n<section class=\"wrap\">\n\n  <div class=\"ozet\">\n    <h2>The short answer<\/h2>\n    <ul>\n      <li><b>A low MELD score should never stop a referral.<\/b> Fluid in the abdomen,\n          confusion or bleeding from varices mean you should be referred <b>immediately<\/b>.<\/li>\n      <li><b>Being very sick is not a reason to refuse.<\/b> A MELD score above 40, or\n          acute-on-chronic liver failure, is not a contraindication.<\/li>\n      <li><b>There is no age limit.<\/b> Frailty is measured \u2014 but it is not, on its own, a\n          reason to say no.<\/li>\n      <li><b>Weight alone does not exclude you<\/b>, and neither does a fixed number of months\n          without alcohol.<\/li>\n      <li>What does rule a patient out: <b>heart disease that cannot be treated, severe\n          pulmonary hypertension, or active cancer<\/b>.<\/li>\n    <\/ul>\n  <\/div>\n\n  <h2>When should you be referred?<\/h2>\n\n  <p>Transplant teams use the <b>MELD score<\/b> \u2014 a number calculated from blood tests\n     (bilirubin, INR, creatinine and sodium) \u2014 to measure how severe liver disease is. The\n     higher the score, the more urgent the need.<\/p>\n\n  <p>According to the American guideline, patients on the waiting list may begin to benefit\n     from a transplant at a MELD score <b>above 12<\/b>, and referral at 15 remains reasonable.\n     But the guideline is clear that <b>a lower MELD score should never be a barrier to\n     referral<\/b>.<\/p>\n\n  <div class=\"box\">\n    <span class=\"etiket\">Do not wait for the number \u2014 refer immediately if you have<\/span>\n    <ul>\n      <li><b>Ascites<\/b> \u2014 fluid building up in the abdomen<\/li>\n      <li><b>Hepatic encephalopathy<\/b> \u2014 confusion, drowsiness, personality change<\/li>\n      <li><b>Variceal bleeding<\/b> \u2014 vomiting blood or black stools<\/li>\n    <\/ul>\n    <p>These are signs that the liver is failing, whatever the MELD score says.<\/p>\n  <\/div>\n\n  <h2>\"You are too sick for a transplant\"<\/h2>\n\n  <p>This is one of the hardest things a family can hear \u2014 and the guidelines do not support\n     it as a blanket rule. The American guideline states that <b>neither a MELD score above 40\n     nor acute-on-chronic liver failure (ACLF) is a contraindication<\/b>. The European\n     guideline recommends that patients with the most severe grade of ACLF be evaluated.<\/p>\n\n  <p>Very sick patients carry higher risk, and not every one of them will be suitable. But\n     the decision should come from a full evaluation \u2014 not from the score alone.<\/p>\n\n  <h2>\"You are too old\"<\/h2>\n\n  <p>Neither guideline sets an upper age limit. Older candidates are assessed carefully for\n     <b>heart and lung fitness, nutrition and frailty<\/b>.<\/p>\n\n  <p>Frailty \u2014 how physically strong and independent a patient is \u2014 matters, because frail\n     patients recover more slowly. Both guidelines say it should be <b>measured with\n     standard tests<\/b>, not judged by eye, and that frailty <b>on its own is not a reason to\n     refuse<\/b>.<\/p>\n\n  <h2>\"You weigh too much\"<\/h2>\n\n  <p>The American guideline states that patients <b>should not be excluded from evaluation\n     based on BMI alone<\/b>. Patients with a BMI above 40, or below 18.5, need a nutrition\n     assessment \u2014 not an automatic no.<\/p>\n\n  <p>The European guideline goes further for patients with a BMI above 35: weight-loss\n     surgery may be done <b>before<\/b> the transplant if the cirrhosis is still compensated,\n     or <b>at the time of or after<\/b> the transplant if it is not.<\/p>\n\n  <h2>\"You must stop drinking for six months first\"<\/h2>\n\n  <p>For years, many centres required six months without alcohol before a patient could even\n     be listed. The current guidelines have moved away from this.<\/p>\n\n  <ul>\n    <li>The American guideline states that <b>the length of abstinence should not be a\n        criterion for excluding a patient<\/b> from the list \u2014 particularly when the liver is\n        too sick to wait.<\/li>\n    <li>The European guideline sets <b>no fixed abstinence period<\/b>, and allows early\n        transplantation for <b>selected patients with severe alcohol-related hepatitis<\/b>\n        who do not respond to medical treatment.<\/li>\n  <\/ul>\n\n  <p>This does not mean alcohol does not matter. Both guidelines expect a\n     <b>multidisciplinary assessment<\/b>, and patients on the list continue to be\n     <b>monitored for alcohol use<\/b>. A commitment to stop drinking is part of the\n     agreement.<\/p>\n\n  <div class=\"soru\">\n    <h3>Every centre does not follow the same rule<\/h3>\n\n    <p>Guidelines describe best practice; individual centres still set their own policies.\n       If you have been refused because of a fixed abstinence period, it is reasonable to ask\n       whether that centre's rule reflects the current guidelines \u2014 and to seek a second\n       opinion.<\/p>\n  <\/div>\n\n  <h2>Liver cancer (hepatocellular carcinoma)<\/h2>\n\n  <p>A liver transplant can cure some patients with liver cancer, because it removes the\n     tumour and the diseased liver together. Selection matters, because cancer can return\n     after transplantation.<\/p>\n\n  <ul>\n    <li>The <b>Milan criteria<\/b> remain the standard: a single tumour up to 5 cm, or up to\n        three tumours each up to 3 cm, with no spread into blood vessels or outside the\n        liver.<\/li>\n    <li>Patients <b>beyond<\/b> the Milan criteria may still be considered if treatment first\n        shrinks the cancer back within limits \u2014 known as <b>downstaging<\/b>.<\/li>\n    <li>A tumour marker (<b>AFP<\/b>) above <b>1,000 ng\/ml<\/b> is a warning sign: the European\n        guideline advises against transplantation unless treatment brings it down and keeps\n        it down.<\/li>\n  <\/ul>\n\n  <p>Living donor transplantation may offer options to some patients beyond the Milan\n     criteria, but there is no international agreement on how far these limits can be\n     extended.<\/p>\n\n  <h2>What genuinely rules a patient out<\/h2>\n\n  <div class=\"tblwrap\">\n    <table>\n      <thead>\n        <tr><th>Condition<\/th><th>Why<\/th><\/tr>\n      <\/thead>\n      <tbody>\n        <tr><td><b>Significant coronary artery disease that cannot be treated<\/b><\/td><td>The heart cannot safely survive the operation<\/td><\/tr>\n        <tr><td><b>Severe pulmonary hypertension<\/b> (mean pressure above 45 mmHg despite treatment)<\/td><td>Very high risk of death during and after surgery<\/td><\/tr>\n        <tr><td><b>Active cancer<\/b> (except selected slow-growing cancers)<\/td><td>Anti-rejection medicines can speed its growth<\/td><\/tr>\n        <tr><td>Complete clotting of the portal vein system (grade IV)<\/td><td>A relative contraindication \u2014 needs specialist assessment<\/td><\/tr>\n        <tr><td>No reliable support at home, or untreated mental illness<\/td><td>Recovery depends on taking medicines and attending follow-up<\/td><\/tr>\n      <\/tbody>\n    <\/table>\n  <\/div>\n\n  <p>Mental health conditions are <b>not an absolute contraindication<\/b> if they are treated\n     and stable. Every candidate has an ECG and an echocardiogram of the heart.<\/p>\n\n  <h2>The living donor option<\/h2>\n\n  <p>Because a liver can regrow, part of a healthy person's liver can be transplanted. For\n     patients travelling to Turkey, a transplant means <b>a living donor<\/b> \u2014 usually a\n     family member.<\/p>\n\n  <ul>\n    <li>The donor must keep <b>at least 30%<\/b> of their own liver.<\/li>\n    <li>The part given must be large enough for the recipient \u2014 generally <b>more than 40%<\/b>\n        of the recipient's expected liver volume, or <b>more than 0.8%<\/b> of their body\n        weight.<\/li>\n    <li>Living donor transplantation is beneficial even at <b>lower MELD scores<\/b>, because\n        it can be done before complications develop.<\/li>\n  <\/ul>\n\n  <p>Who can legally be your donor in Turkey, and what to check before choosing a centre, is\n     explained in <a href=\"https:\/\/bookinghospital.org\/az\/turkiy\u0259d\u0259-qaraciy\u0259r-transplantasiyasi\/\">Liver transplant in Turkey: the facts\n     and what to check<\/a>.<\/p>\n\n  <div class=\"box efsane\">\n    <span class=\"etiket\">The myth<\/span>\n    <p><b>\"If they said no once, the answer is no.\"<\/b><\/p>\n    <p>A refusal based on age, weight, a MELD score or a fixed number of sober months may not\n      reflect current international guidelines. Ask what the specific medical reason was \u2014\n      and get a second opinion.<\/p>\n  <\/div>\n\n  <div class=\"yazar\">\n    <div class=\"rozet\">MT<\/div>\n    <div>\n      <h3>Medically reviewed by <a href=\"https:\/\/bookinghospital.org\/az\/murat-tuncer-md\/\" style=\"color:inherit\">Prof. Dr. Murat Tuncer<\/a><\/h3>\n      <p>Nephrologist and transplant physician. This guide was prepared by the BookingHospital medical\n        team from the current European (EASL) and American (AASLD\/AST) liver transplantation\n        guidelines.<\/p>\n    <\/div>\n  <\/div>\n\n  <div class=\"cta\">\n    <h2>Turned down for a liver transplant? Send us your reports<\/h2>\n    <p>Send your latest blood tests, imaging and the reason you were given. We will tell you\n       honestly whether an evaluation is worthwhile \u2014 including when the answer is no.<\/p>\n    <div class=\"btns\">\n      <a class=\"btn btn-1\" href=\"https:\/\/bookinghospital.org\/az\/tibbi-turizm\/\">Send your medical reports<\/a>\n    <\/div>\n  <\/div>\n\n  <div class=\"uyari\">\n    <p><b>Medical disclaimer.<\/b> This article is general information based on published\n      international guidelines. It is not personal medical advice, it does not establish a\n      doctor\u2013patient relationship, and it cannot replace assessment by the physician treating\n      you. Eligibility for liver transplantation is decided by a transplant team after\n      detailed testing. Always consult a transplant centre before making decisions about your\n      treatment.<\/p>\n  <\/div>\n\n  <div class=\"kaynak\">\n    <h3>References<\/h3>\n    <ol>\n      <li>European Association for the Study of the Liver. EASL Clinical Practice Guidelines on\n        liver transplantation. <i>J Hepatol<\/i> 2024;81(6):1040\u20131086.<\/li>\n      <li>Dove L, Chadha RM, Lai JC, et al. AASLD AST Practice Guideline on Adult Liver\n        Transplantation: Candidate Evaluation. <i>Hepatology<\/i> 2025;83(6):1609\u20131645.<\/li>\n      <li>Miller CM, Quintini C, Dhawan A, et al. The International Liver Transplantation\n        Society Living Donor Liver Transplant Recipient Guideline. <i>Transplantation<\/i>\n        2017;101(5):938\u2013944.<\/li>\n    <\/ol>\n  <\/div>\n\n<\/section>\n\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Liver transplantation \u00b7 Who can receive Told you are too sick, too old or too heavy for a liver transplant? Many patients are turned away for reasons that the latest international guidelines no longer accept. Here is what the European and American liver societies actually recommend \u2014 and what genuinely rules a patient out. Based [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"elementor_header_footer","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"_joinchat":[],"footnotes":""},"categories":[17],"tags":[],"class_list":["post-2996","post","type-post","status-publish","format-standard","hentry","category-liver-transplant-guide"],"_links":{"self":[{"href":"https:\/\/bookinghospital.org\/az\/wp-json\/wp\/v2\/posts\/2996","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/bookinghospital.org\/az\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/bookinghospital.org\/az\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/bookinghospital.org\/az\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/bookinghospital.org\/az\/wp-json\/wp\/v2\/comments?post=2996"}],"version-history":[{"count":4,"href":"https:\/\/bookinghospital.org\/az\/wp-json\/wp\/v2\/posts\/2996\/revisions"}],"predecessor-version":[{"id":3001,"href":"https:\/\/bookinghospital.org\/az\/wp-json\/wp\/v2\/posts\/2996\/revisions\/3001"}],"wp:attachment":[{"href":"https:\/\/bookinghospital.org\/az\/wp-json\/wp\/v2\/media?parent=2996"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/bookinghospital.org\/az\/wp-json\/wp\/v2\/categories?post=2996"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bookinghospital.org\/az\/wp-json\/wp\/v2\/tags?post=2996"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}