Introduction

Many people requiring liver transplant die while waiting for a donor. A liver transplant enhances the life of the patient. Thus, liver transplantation must be done in those patients who urgently need them and have the chance for a healthy life after liver transplant. Certain factors are considered while evaluating the patient for liver transplantation.

Meld And Its Importance

Model End-Stage Liver Disease and Pediatric End-Stage Liver Disease is a point-based system that is applied to determine the urgency of Liver transplantation in adults and children less than 12 years respectively. The MELD score has a value between 6 and 40. Higher the score, the higher would be the need for liver transplantation. The number also depicts when the next liver evaluation would be done.

The MELD scores are based on various laboratory tests of the patients including the ability of liver in synthesizing clotting factors, creatinine level, bilirubin level, and serum sodium level. The patient with a high MELD score is given priority on the waiting list.

Factors Considered For Liver Transplant

Liver transplantation is a complex surgery. Not all people are eligible to undergo liver transplantation. Because of the limited number of donors, it is prudent to provide liver to those patients who fulfill the eligibility criteria. Comprehensive health evaluation is done by the liver transplant team before giving a go-ahead for a liver transplant. The transplant team comprises hepatologist, physician, anesthetist, and nutritionist. Following are some of the factors considered by the liver transplant team while evaluating a patient for liver transplant:

Age: Age is one of the important parameters considered for a liver transplant. Although there is no upper age limit for a liver transplant, people above the age of 70 years are generally not offered liver transplant because of poor recovery and success rate.

Underlying medical conditions: Liver transplant is a complicated surgery. Thus, a completely healthy body is required to undergo a liver transplant to bear the physical and mental stress. Patients with uncontrolled hypertension and poorly managed diabetes are not considered until these are properly managed.

Mental Strength: The patient should not suffer from anxiety, depression, or any other psychiatric disorder. There are cases when there is an increased severity of neurological diseases after liver transplantation.

Alcohol abuse:If the patient has alcohol and/or drug abuse, has an unhealthy lifestyle, and smokes too often, the liver transplant team advises the patient to change the lifestyle and refrain from drinking and smoking. The patient should be re-evaluated after a given time.

The severity of liver damage: Not all patients of the liver disease require immediate liver transplantation. The patient is evaluated based on the severity of liver damage and the urgency of transplantation. 

Medical compliance: If the patient has documented a history of medical non-compliance, he may not be considered for liver transplantation. It is because noncompliance done after transplant surgery may lead to failure of the transplant.

Extrahepatic Cancer: Patients with serious malignant disease outside the liver are generally not considered for a liver transplant. 

Uncontrolled infection: Patients with serious and uncontrolled infections are not the candidates for liver transplant surgery. Further, those with serious and irreversible brain damage are not a good candidate for liver transplant surgery.

Social support: Recovery from liver transplant surgery requires a long time and care. The patient should have the support of family members and friends for routine tasks, medications, and taking the patient to the hospital for a routine check-up.

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