saudigastro.com/patients/liver-transplant-evaluation
Category
Serious
Red flags
5
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
A liver transplant is an operation in which a diseased liver is replaced by a healthy liver from a donor. It is considered when the liver can no longer do its job and other treatments are not enough, for example in advanced cirrhosis (severe scarring), sudden liver failure, some liver cancers within set limits, and certain inherited or bile duct diseases. Before you can be listed, a transplant team carries out an evaluation: a series of tests and meetings to check that transplant is needed, that it is safe for you, and that you and your family are ready.
How common is it?
Transplant is an option for a limited number of people with advanced liver disease. The number of available donor livers is lower than the number of people who need them, so waiting times and priorities are set by the transplant centre and national allocation rules.
Why does it happen?
People are referred when liver disease reaches a stage where complications appear or the liver function is poor. Examples are fluid in the belly (ascites), bleeding from swollen veins in the gullet, confusion from toxins building up (hepatic encephalopathy), jaundice that is getting worse, or liver cancer within suitable limits. The common underlying causes include hepatitis B and C, fatty liver disease, alcohol-related liver disease, autoimmune and bile duct diseases. The decision is made by the team after considering how sick the liver is and how well you are otherwise.
Symptoms
- Swelling of the belly or legs from fluid
- Yellowing of the skin and eyes (jaundice) and itching
- Marked tiredness, muscle wasting and weight loss
- Confusion, sleepiness or day-night reversal (hepatic encephalopathy)
- Easy bruising or bleeding
- Vomiting blood or black stool from swollen veins
Red flags — seek urgent medical care
Vomiting blood or passing black or bloody stool
Bleeding from swollen veins. Call emergency services or go to the hospital immediately.
New confusion, extreme sleepiness or difficulty waking
Possible hepatic encephalopathy or infection. Seek emergency care.
Fever or chills, or belly pain with a tense, swollen belly
Possible infection of the belly fluid. Needs urgent hospital assessment.
Passing very little urine, or rapid weight gain from swelling
Possible kidney problem or worsening fluid. Contact your transplant team the same day.
Any call from the transplant centre about an available liver
Follow their instructions exactly and go to the hospital without delay.
How is it diagnosed?
The evaluation is a thorough check, usually over several visits. It includes blood tests (liver function, blood group, kidney function, infection screening), imaging of the liver and its blood vessels, tests of the heart and lungs, sometimes endoscopy and a colonoscopy, cancer screening suited to your age, a dental check, and review by a dietitian, a social worker and a psychologist or psychiatrist. For liver cancer, scans define whether it is within accepted limits. At the end, a team meeting decides whether to place you on the waiting list, to treat other problems first, or to continue other treatments instead.
What the latest science says
Allocation systems use a score based on blood tests to rank how urgently a person needs a transplant, and extra consideration may be given for some liver cancers. Transplant from a living donor and from a donor after circulatory death are options in some programmes. Better care of complications while waiting also improves safety. Rules differ between centres and countries, so your own team will explain how it works for you.
Outlook — what to expect
Many people who receive a transplant return to a good quality of life. Waiting can be uncertain and stressful: some people become sicker while waiting, and a few cannot be transplanted if their condition changes. Staying as healthy as possible, taking medicines as prescribed and keeping in contact with the team improves your chances.
Treatment
Habits & Lifestyle
While you wait, your goal is to stay as strong and stable as possible so you are ready for surgery at any time.
- Keep your phone on and charged, and make sure the team has current contact numbers, including a family member.
- Keep a bag ready with your documents, medicine list and personal items, and plan transport to the hospital.
- Do not drink alcohol, do not smoke, and avoid recreational drugs.
- Stay as active as your condition allows to protect muscle strength.
- Keep vaccinations up to date as advised by the team, and avoid contact with people who are unwell.
- Tell the team immediately about any new illness, infection, hospital visit or change in your medicines.
Diet
Good nutrition protects you from muscle loss and infection while waiting. A dietitian from the team will tailor advice.
- Eat small, frequent meals and a bedtime snack with some protein and carbohydrate; this helps prevent muscle loss.
- Do not restrict protein unless the team tells you to; people with cirrhosis usually need enough protein.
- If you have fluid retention, limit salt as advised; avoid salty foods, canned and processed foods and salty pickles.
- Avoid raw or undercooked meat, fish and shellfish and unpasteurised dairy because infections are more dangerous in liver disease.
- Check with the team before taking any herbal or traditional remedies, which may harm the liver.
Medications
Medicines treat complications and the underlying liver disease while you wait. Take them exactly as prescribed.
- Water tablets (diuretics) help control fluid in the belly and legs.
- Medicines to lower pressure in the swollen veins may be used to reduce bleeding risk.
- Medicines such as lactulose or rifaximin help prevent or treat confusion from hepatic encephalopathy.
- Treatment for the cause (for example antivirals for hepatitis B or C) may be continued or started.
- Avoid painkillers such as NSAIDs and any new medicine or supplement unless the team approves.
Procedures & Surgery
Procedures can keep you well and treat complications until a liver becomes available.
- Draining fluid from the belly (paracentesis) relieves tight swelling.
- Endoscopic banding (placing tiny rubber bands) treats swollen veins that could bleed.
- For liver cancer, treatments that destroy or block the tumour may be used to keep it within limits while waiting.
- A special tube (shunt) inside the liver may be considered for some patients with severe fluid or bleeding.
- The transplant operation itself is major surgery done by a specialist team, and your team will explain the risks and recovery.
Living with the condition
- Waiting is emotionally hard. Ask about psychological support and talk openly with family.
- Ask about options such as a living donor and what each involves.
- Make financial, work and travel plans with the team's advice, since you may need to stay near the transplant centre.
In the Saudi context
Organ donation and transplantation are accepted in Islam by many scholars and are carried out in specialised centres in the Kingdom. Ask your transplant team about the process and about how to arrange the evaluation. Fasting in Ramadan may not be safe while you have advanced liver disease, so discuss it with your team in advance.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- Do I need a liver transplant, and why now?
- What tests does the evaluation include?
- How is priority on the waiting list decided?
- Could a living donor be an option for me?
- What should I do while waiting, and whom do I call if I get worse?
- What happens if my health changes?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide