Liver Transplant: Eligibility, Surgery, Donors, Risks & Recovery

A liver transplant, also called liver transplantation, is an operation in which a severely diseased or failing liver is removed and replaced with a healthy donor liver.

Unlike kidney transplantation, the patient's diseased liver is normally removed because the transplanted liver must occupy its anatomical position in the upper abdomen.

The donor liver may come from a deceased donor or, in selected cases, from a living donor who gives part of their liver.

The liver is unusual because it has a substantial capacity to regenerate. This makes living donor liver transplantation possible. Surgeons can remove a portion of a healthy donor's liver and transplant it into the recipient, while the remaining liver tissue in both donor and recipient can increase in volume after surgery.

Liver transplant surgery is a major operation and commonly takes several hours. Complex or repeat transplantation may take longer.

After surgery, the recipient normally requires long-term immunosuppressive medication to reduce the risk that the immune system will attack the transplanted liver.

The main types of liver transplantation are classified by the source of the donated liver and whether the entire liver or only part of it is transplanted.

Deceased donor liver transplant

A deceased donor liver transplant uses a liver donated after the donor has died.

The donor liver may be transplanted as a whole organ or, in selected circumstances, divided so that different portions can be transplanted into different recipients.

Deceased-donor organs are distributed through regulated allocation systems. Factors may include medical urgency, compatibility, waiting time, donor and recipient size, geography and national allocation policy.

International patients should not assume they can travel to another country and receive a deceased-donor liver. Residency and allocation restrictions can be significant.

Living donor liver transplant

In a living donor liver transplant, a healthy person gives part of their liver to the recipient.

For many adult-to-adult procedures, the larger right lobe may be used. Smaller portions may be used when the recipient is a child.

Living donation can allow transplantation to be planned in advance and may reduce dependence on a deceased-donor waiting list.

However, it exposes a healthy donor to major abdominal surgery, making donor safety and independent consent central to the process.

Split liver transplant

A deceased donor liver may sometimes be divided so that portions can be transplanted into two recipients, often an adult and a child.

Whether this is possible depends on donor anatomy, liver quality, recipient size and transplant-centre expertise.

A liver transplant may be considered when liver disease becomes so advanced that medical treatment can no longer provide adequate long-term survival or when a patient develops acute liver failure that is unlikely to recover.

For suitable patients, transplantation may be the only treatment capable of restoring sufficient liver function.

The transplant team must determine that the expected benefits of surgery are greater than the risks of transplantation and long-term immunosuppression.

Conditions that may lead to liver transplantation

Decompensated cirrhosisAlcohol-related liver diseaseMetabolic dysfunction-associated steatotic liver diseaseChronic hepatitis BChronic hepatitis CAutoimmune hepatitisPrimary biliary cholangitisPrimary sclerosing cholangitisAcute liver failureSelected hepatocellular carcinomaCertain inherited metabolic liver diseasesSome congenital liver disordersSelected vascular or cholestatic liver diseases

Not every patient with one of these conditions requires or qualifies for transplantation.

Living liver donation requires a detailed and independent assessment because a healthy person is accepting surgical risk for another person's benefit.

A potential donor must be healthy enough for major surgery, have appropriate liver anatomy and function, understand the procedure and its risks, and be able to provide voluntary informed consent.

The donor liver segment must also be suitable for the recipient while leaving enough healthy liver tissue for the donor.

The transplant team evaluates the donor separately from the recipient so that the donor's interests remain independently protected.

Typical donor assessment

General health : Medical history and physical examinationLiver function : Liver blood tests and other function testsLiver anatomy : CT, MRI or other imagingLiver fat : Imaging and additional assessment where neededBlood compatibility : Blood groupCardiovascular health : ECG and additional testing where indicatedInfection screening : Relevant transmissible infectionsCancer risk : Age- and risk-appropriate screeningPsychological readiness : Motivation, understanding and mental wellbeingSurgical suitability : Liver volume, blood vessels and bile-duct anatomyLegal and ethical assessment : Identity, relationship, voluntary consent and absence of payment A living donor generally needs to:

A liver transplant is major surgery and can cause complications during the operation, during the early recovery period or years later.

Risk varies according to the patient's liver disease, age, nutritional status, cardiovascular health, kidney function, infection history, previous abdominal surgery, immune status and donor characteristics.

Some complications can be treated successfully when detected early, but liver transplantation can also cause serious or life-threatening problems.

Preparation for liver transplantation is extensive because the transplant team must determine whether the patient is likely to benefit from surgery and whether they can safely tolerate the operation.

Assessment considers the severity of the liver disease as well as cardiovascular, respiratory, kidney, infectious, nutritional, cancer and psychosocial risks.

Current transplant guidance emphasises multidisciplinary assessment rather than relying on one laboratory result or score alone.

Assessment may include:

Liver transplant surgery is performed under general anaesthesia.

The surgeon makes an abdominal incision and carefully separates the diseased liver from surrounding tissues and blood vessels.

The diseased liver is then removed.

The donor liver, or donated part of a liver, is placed in the recipient's upper abdomen. The surgical team reconnects the major blood vessels so blood can flow through the transplanted liver.

The bile duct is then reconstructed so bile can drain from the new liver into the digestive system.

Because advanced liver disease can affect blood clotting, blood loss and coagulation are closely monitored throughout the operation. Blood products may be required.

A liver transplant commonly takes approximately 5–8 hours, although complex or repeat surgery can take longer.

After surgery, most patients are transferred to an intensive care unit for close observation.

What is monitored after surgery?

Liver enzymesBilirubinINR and clottingBlood pressureKidney functionUrine outputElectrolytesBlood countImmunosuppressant levelsSigns of infectionBleedingBile-duct complicationsBlood flow through the transplanted liverSigns of rejection

There is no single worldwide liver transplant success rate.

Outcomes depend on the recipient's diagnosis, age, severity of illness, kidney function, cardiovascular health, infection status, cancer status, donor characteristics, transplant-centre experience and post-transplant care.

For appropriately selected patients, a liver transplant can significantly improve survival and quality of life.

Published national statistics should be used as population benchmarks rather than promises about an individual patient's outcome.

Published outcome benchmarks

Patients alive 1 year after liver transplant : About 93 in 100Patients alive 5 years after liver transplant : About 83 in 100Typical surgery duration : About 5–8 hoursTypical hospital stay : Around 7–14 days

These figures are population-level benchmarks and must not be presented as guarantees.

Outcomes reported in other countries may differ because donor systems, patient populations, allocation rules and clinical practices are different.

Recovery after a liver transplant happens in stages.

The early period focuses on confirming that the transplanted liver is functioning, controlling bleeding, preventing infection and establishing the correct immunosuppressive treatment.

Most recipients initially require intensive monitoring. Follow-up remains particularly frequent during the first weeks and months.

Liver transplant recovery timeline

Surgery : Approximately 5–8 hoursFirst 1–3 days : Intensive monitoring, often in ICUHospital stay : Commonly around 7–14 daysFirst weeks : Frequent blood tests and medication adjustmentsAround 8 weeks : Moderate activity may gradually increase if clearedAround 12 weeks : Some patients may resume driving when medically approved3–6 months : Many patients can return to work depending on recoveryFirst 6 months : Close rejection and infection monitoringLong term : Ongoing follow-up and immunosuppressive treatment

International patients should not assume they can fly home immediately after hospital discharge.

Before travelling home, the transplant centre should confirm that the patient is medically stable and that a clear plan exists for laboratory testing, medication monitoring and specialist follow-up.

A successful liver transplant can dramatically improve health and daily function in a person with advanced liver disease.

Symptoms such as jaundice, severe fatigue, ascites, confusion and poor nutritional status may improve as the transplanted liver begins to function.

However, transplantation does not mean that medical care is finished.

Recipients usually require long-term immunosuppressive medicines to reduce the risk of rejection. These medicines can increase susceptibility to infections and may contribute to kidney dysfunction, high blood pressure, diabetes and certain cancers.

Long-term follow-up therefore remains essential even when the recipient feels well.

The cost of a liver transplant varies considerably between countries and transplant centres.

For international patients, the total price may depend on recipient evaluation, living-donor assessment where applicable, surgery, anaesthesia, intensive care, hospital stay, laboratory testing, blood products, medicines and early post-transplant monitoring.

The amount displayed below is pulled from the platform's verified price registry so that pricing can be updated centrally.

A legitimate transplant price covers medical and associated services. It must never represent payment for the donor liver itself.

Liver transplantation should be performed only by appropriately authorised transplant programmes with the multidisciplinary expertise and infrastructure required to evaluate recipients, protect living donors, perform complex liver surgery and provide intensive postoperative care.

The hospitals displayed below are generated from the platform's verified provider and price registry rather than manually inserted into this article.

A centre should appear only after its liver transplant programme and relevant pricing information have been verified.

Being listed does not mean that every patient or donor will be accepted. Final eligibility requires individual medical, donor, ethical and legal assessment.

Liver transplantation is available in many countries, but the existence of a transplant programme does not mean that international patients automatically qualify for treatment there.

Rules can differ substantially between living-donor and deceased-donor transplantation.

A country may accept eligible international patients for a living donor liver transplant when they arrive with an approved donor but restrict deceased-donor organs to residents or people registered within its national allocation system.

Other countries may require a specific donor relationship, independent ethics approval or government authorisation.

International patients should verify:

Evaluation is thorough because the question is not only whether a transplant would help, but whether this person can safely undergo one and sustain it. Assessment usually covers cardiac and respiratory fitness, infection and cancer screening, nutritional state, dental health, and whether lifelong medication and follow-up are practically achievable.

Where liver disease is related to alcohol, programmes generally require a documented period of abstinence with support in place. That is not a moral position: it is because the same injury will recur in the new liver, and because the assessment has to establish that the transplant will hold.