Eligibility for Liver Transplant: Who Qualifies and What Factors Matter

When your liver can’t keep up with the job of filtering toxins, making proteins, or storing energy, a liver transplant, a surgical replacement of a failing liver with a healthy one from a donor. It’s not a first resort—it’s the last option when other treatments have failed. This isn’t just about having a damaged liver. There’s a strict set of rules doctors follow to decide who gets on the waiting list. The system isn’t first-come, first-served. It’s based on how badly your liver is failing and how likely you are to survive the surgery and recovery.

One of the biggest factors is cirrhosis, a late-stage scarring of the liver caused by long-term damage from alcohol, hepatitis, or fatty liver disease. Most people who get transplants have cirrhosis that’s progressed to the point where medications and lifestyle changes no longer help. Doctors use the MELD score, a numerical scale that predicts 90-day survival based on blood tests for bilirubin, creatinine, and INR to rank patients. The higher your MELD score, the sicker you are—and the higher your priority on the list. A score above 15 usually means you’re in the danger zone. But even if your score is high, you still need to be healthy enough to survive surgery. That means no active infections, no uncontrolled cancer outside the liver, and no serious heart or lung problems.

It’s not just about your liver. Your overall health matters. If you’re still drinking alcohol or using drugs, you won’t qualify until you’ve been sober for at least six months—and you’ll need proof you can stay that way. Mental health is checked too. Depression or untreated anxiety can make recovery harder. You also need a strong support system. Transplant recovery isn’t something you do alone. You’ll need someone to drive you to appointments, help you take pills, and notice if something’s going wrong. And yes, your ability to pay for lifelong anti-rejection drugs and follow-up care is part of the evaluation. Insurance coverage, Medicaid, or financial assistance programs are reviewed carefully.

Some conditions automatically disqualify you. If you have advanced cancer that’s spread beyond the liver, a transplant won’t help. If you have severe, untreated mental illness that makes it impossible to follow complex medication schedules, you won’t be approved. Even obesity or smoking can delay your candidacy—you’ll need to get your weight down and quit before moving forward.

What you’ll find in the posts below isn’t a list of who qualifies. It’s a collection of real-world stories and medical insights that show what happens before, during, and after the transplant process. From how liver failure changes your daily life, to how medications like pravastatin or metformin interact with transplant drugs, to how to avoid dangerous drug interactions with supplements like 5-HTP, these posts give you the practical side of what most guides leave out. You’ll see how patient counseling catches errors, how side effects are managed, and how people stay alive while waiting. This isn’t theoretical. It’s what people actually deal with when they’re fighting for a second chance.