Liver transplantation may be indicated in cases of acute or chronic liver failure. In either instance, there are strict criteria which must be fulfilled before a patient is considered eligible for consideration for transplantation.
Patients with acute liver failure are usually managed on the liver intensive care unit from the outset. Patients with chronic liver disease may require liver intensive care if they should become unwell while on the waiting list. 20% of patients will die while waiting for a suitable organ to become available.
Patients from the UK/EU are eligible for a cadaveric organ. Alternatively, living donor liver transplantation is available, with the main benefit being that the risk of dying whilst waiting for an organ to become available is very much less.
Overseas patients without access or entitlement to cadaveric organs may be considered for living donor liver transplantation, as above.
The safety of the donors is paramount. They are subject to careful hepatological and cardiopulmonary evaluation. Although donor hepatectomy is major surgery, it can be considered to be a 'safe' operation in experienced centres. Internationally, the risk of death of the donor is reported to be 1:200 to 1:300.