The shortfall in the number of donated livers led to an agreement between all the liver transplant units in The United Kingdom and the Republic of Ireland to consider livers donated for transplantation as a national resource.
When a suitable liver, assessed on size and blood group compatibility, becomes available patients requiring an urgent liver transplant are given priority. The transplant units operate a points system to ensure that urgent cases are dealt with first. The system also ensures that no transplant unit continually loses out by passing on livers to other units.
If you are co-infected with HIV you should now qualify for a transplant following improving survival rates of co-infected transplant patients in the USA. Up until recently survival rates were close to zero, partly because of the need to take immunosuppressants and the consequent effect on an already compromised immune system.
The shortage of donors means that decisions about who receives a donated liver are not made simply on medical need alone. It may be that a patient urgently needs a transplant, but if there is a high risk that they will only live a short time, even if the operation is successful, it is unlikely they will be offered one.
There is a list of guidelines that has been agreed between all the units covering a patient’s suitability for a transplant. A panel of doctors and health care workers considers each case and weigh up various factors for consideration.
These are some of the factors taken into account by the medical panels:
- Level of need. People are only considered for a transplant if they have end-stage liver disease or sudden liver failure.
- Age. Elderly people are not usually offered transplants because of the small chances of surviving the operation. However, there is no upper age limit and healthy people in their seventies have successfully undergone transplants.
- Physical condition. State of health apart from the condition of the liver is taken in consideration. If you have other serious medical conditions, such as heart or lung disease, then the chances of being put on the waiting list are much lower as the risks of the operation are greatly increased.
- Probability of success. Generally people are only accepted for transplantation if there is at least a 50% probability that they will still be alive 5 years after the operation, with a quality of life that is acceptable to the patient. If the patient’s condition deteriorates whilst waiting for a liver so that these criteria are no longer met, it is likely that the patient will be removed from the list. This will only be after full discussion with them and friends or family. Such patients - although in greatest need - are at greatest risk of not benefiting after transplantation.
- Match. The donor and recipient must be of approximately similar size and of compatible blood types. For people with a rare blood type then it is much more difficult to find a suitable organ.
- Timing. Eligibility for transplant will occur during the period of time in which someone is thought capable of withstanding major surgery and at the same time having sufficiently advanced liver disease to necessitate a transplant. This is usually considered to be the last year of the life of your liver.
You cannot jump the queue for a donated liver even if you have the funds or the insurance to go privately.