Key points
- A transplant is considered for decompensated cirrhosis, acute liver failure, selected liver cancers and certain metabolic and childhood liver diseases.
- MELD (adults) and PELD (children under 12) scores estimate the short-term risk of dying from liver disease. Higher numbers mean more urgency — they are guides, not the whole decision.
- The work-up checks the liver, heart, lungs, kidneys, infections, dental health, nutrition and the family's ability to support recovery.
- In a planned living donor transplant, evaluation usually takes days to a couple of weeks; in acute liver failure it is compressed into hours.
Who needs a liver transplant?
- Decompensated cirrhosis: cirrhosis from any cause — alcohol, hepatitis B or C, fatty liver, autoimmune disease — once it causes ascites, jaundice, hepatic encephalopathy, variceal bleeding or kidney problems. See liver cirrhosis.
- Acute liver failure and acute-on-chronic liver failure: when the liver fails over days or weeks and does not recover with intensive care. See acute liver failure.
- Liver cancer (HCC) within accepted size and number limits, usually in a cirrhotic liver where resection is unsafe. See liver cancer surgery.
- Children with biliary atresia, metabolic diseases or liver failure; see paediatric liver transplant.
- Other situations: severe itching or recurrent cholangitis in cholestatic diseases, and certain inherited metabolic diseases even when the liver itself is not scarred.
International guidance commonly advises referral for transplant assessment once a patient with cirrhosis has a MELD score of around 15, or at the first major complication, whichever comes first. Referral does not mean immediate surgery; it means the team can plan while the patient is still well enough to benefit.
MELD and PELD scores explained
MELD (Model for End-stage Liver Disease) is calculated from routine blood tests: bilirubin (how well the liver clears bile), INR (how well it makes clotting proteins), creatinine (kidney function) and, in the widely used MELD-Na version, sodium. Newer versions also include albumin and adjust for sex. The score runs from 6 to 40.
| MELD range | What it broadly indicates |
|---|---|
| Below about 15 | Liver disease present, but the risks of transplant often outweigh the benefit if the patient has no complications |
| About 15–20 | The point at which most patients should be assessed by a transplant team |
| About 20–30 | Significant risk of dying from liver disease over the coming months; transplant planning should be active |
| Above about 30 | Very high short-term risk; patients are often in hospital and need urgent transplant |
PELD (Paediatric End-stage Liver Disease) is used for children under 12. It uses bilirubin, INR and albumin, together with the child's age and whether they are failing to grow. As with MELD, a higher PELD indicates a sicker child. Scores are recalculated as new blood tests come in, and in deceased donor allocation they help decide priority; see deceased donor liver transplant.
The tests in a liver transplant work-up
| Area | Typical tests | Why |
|---|---|---|
| Blood | Liver and kidney function, INR, blood counts, blood group (checked twice), tumour marker AFP | Severity, MELD score, compatibility with donors |
| Imaging | Contrast CT or MRI of the abdomen, Doppler ultrasound, chest X-ray or CT | Blood vessel anatomy, clots in the portal vein, liver tumours |
| Heart | ECG, echocardiogram; stress test or coronary angiography for older patients, diabetics or smokers | Whether the heart can withstand a long operation |
| Lungs | Lung function tests, blood oxygen, bubble echocardiogram | Detecting hepatopulmonary syndrome and portopulmonary hypertension, which change risk |
| Infection screening | HIV, hepatitis B and C, CMV, EBV, tuberculosis screening, urine and other cultures | Infections must be treated or planned for before immunosuppression |
| Cancer screening | Age-appropriate checks — for example Pap smear, mammogram, colonoscopy | Hidden cancers elsewhere can rule out transplant |
| Dental and ENT | Dental examination and treatment of infected teeth | Mouth infections can become serious after transplant |
| Nutrition and frailty | Weight, muscle mass, dietitian review, bone density | Malnutrition and frailty slow recovery and are corrected where possible |
| Psychosocial | Assessment by psychologist or psychiatrist and social worker; alcohol and substance history | Adherence to lifelong medicines and family support |
Endoscopy is often done to check for varices. For living donor transplants, the donor has a separate evaluation of their own; see who can be a liver donor. For patients who also have kidney failure, additional kidney assessment is needed — see combined liver–kidney transplant.
When a transplant may not be possible
Some findings make a transplant unsafe or unlikely to help. Some are permanent; others are temporary and can be treated so that the patient becomes eligible.
- Active, uncontrolled infection or sepsis (usually temporary).
- Cancer that has spread outside the liver, or liver cancer well beyond accepted limits.
- Severe heart or lung disease that would make surgery too dangerous, including severe portopulmonary hypertension that does not respond to treatment.
- Ongoing alcohol or drug use. Most programmes require a period of abstinence and commitment to lifelong sobriety; see alcohol and liver transplant.
- Severe frailty or irreversible brain injury.
- No reliable family or caregiver support, or inability to take medicines regularly.
Age alone is not a barrier; carefully selected, fit patients in their late 60s are transplanted at many centres. The decision is made on overall health.
How long evaluation takes and what to bring
For a planned living donor transplant, recipient tests are usually completed over several days to a couple of weeks, often partly as an inpatient. Tests running in parallel for the donor, and the legal approvals, often decide the final date. In acute liver failure, the same essential checks are done within a day or two while the patient is in intensive care.
- All previous reports in date order, scan CDs and written reports, endoscopy reports and discharge summaries.
- A list of current medicines, including herbal and indigenous remedies.
- Government ID for patient and family members (passport and medical visa for international patients — see liver transplant for Bangladesh patients).
- Details of possible living donors and their blood groups, if known.
- Insurance or scheme documents — see liver transplant cost.
While waiting for evaluation or transplant, go to hospital at once for:
vomiting blood or black stools; confusion or excessive sleepiness; fever with abdominal pain; very little urine; or jaundice that deepens quickly. Inform the transplant coordinator as soon as you are admitted anywhere.
Dr Bappaditya Har and the transplant team at Narayana RN Tagore Hospital, Mukundapur, Kolkata, can review reports sent on WhatsApp (+91 70420 39420) before you travel and advise which tests are still needed. For appointments, call 080675 06860.
Frequently asked questions
What MELD score is needed for a liver transplant?
There is no single cut-off. Many patients are referred for assessment at a MELD of around 15, and the risk of dying without transplant rises as the score increases. Complications such as refractory ascites, encephalopathy or liver cancer can make transplant appropriate even at a lower MELD.
What is the difference between MELD and PELD?
MELD is used for adults and children 12 and older, based on bilirubin, INR, creatinine and sodium. PELD is for children under 12 and uses bilirubin, INR, albumin, age and growth.
How long does liver transplant evaluation take?
Usually several days to a couple of weeks for a planned transplant, depending on test results and whether any problem — such as an infection or a dental issue — needs treating first. In acute liver failure, it is done within a day or two.
Can I do the tests in my home town?
Some basic blood tests and scans can be done locally, but key tests are usually repeated at the transplant centre so the team can rely on consistent results. Send existing reports on WhatsApp first so nothing is duplicated unnecessarily.
Can a patient who drank alcohol get a liver transplant?
Yes, if they have stopped drinking, commit to lifelong abstinence and have family support. Programmes assess this carefully. Continued drinking is a reason transplant may not be offered.
What if the evaluation finds a problem?
Many problems, such as dental infections, heart artery narrowing or poor nutrition, can be treated so that transplant can go ahead. The team will explain what needs to happen first.
Related reading
Liver Transplant in Kolkata →
Evaluation, surgery and recovery — the complete transplant pathway.
Living Donor Liver Transplant →
A family member donates part of their liver; both recover.
Who Can Be a Liver Donor? Eligibility, Tests and the Legal Process in India →
Living liver donor eligibility in India — age, blood group, BMI, fatty liver, liver size — the donor tests, THOTA approval and the right to withdraw.
Liver Cirrhosis Treatment in Kolkata: Stages, Care and When to Consider a Transplant →
Cirrhosis explained: compensated vs decompensated, Child-Pugh and MELD in plain words, what treatment can and cannot do, and when to consider a transplant.
Liver Transplant Cost in Kolkata →
What drives the cost and how families plan for it.
Recovery After a Liver Transplant: From Theatre to the First Three Months →
What recovery after a liver transplant looks like: ICU and ward days, drains, hospital stay, discharge, early blood tests, complications and when to call.
This page is general patient information, not a diagnosis or a substitute for a consultation. Treatment decisions depend on each patient's reports and examination. Read our medical disclaimer and editorial policy.