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This slide shows how to get on the list. There are 3 broad categories of diseases where the patient ends up having a high chance of dying within the next few months and are suitable for listing for transplantation. The most common cause is cirrhosis, the next most common cause is hepatocellular carcinoma, and a third cause, which doesn't occur very often, is fulminant hepatitis.
Does everybody with cirrhosis end up being referred for transplant? The answer is no. You can live for many, many years with cirrhosis. Once you have a decompensation of cirrhosis your mortality goes way up, and your survival goes down. By decompensation I'm talking about, for example, ascites, a variceal hemorrhage (VH), or hepatic encephalopathy (HE). Other, generally later, forms of decompensation include spontaneous bacterial peritonitis and hepatorenal syndrome. Another one is a somewhat high MELD score, but there are discussions about setting the MELD score at a minimum of 10 before a patient can be listed for transplant. So when a patient experiences decompensation, that's when liver disease is bad enough for consideration of transplant referral in suitable candidates.
What about liver cancer? The bottom line is, patients should be referred as early as possible.
Acute, fulminant hepatitis is rare, but if such a patient develops hepatic encephalopathy, this is one marker that they may be so sick that a referral for consideration of listing for transplant may be in order.
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