Eligibility for Liver Transplant: Who Qualifies and What Matters Most

When your liver can’t keep up anymore, a liver transplant, a surgical replacement of a failing liver with a healthy one from a donor. Also known as hepatic transplant, it’s often the only lifeline for people with end-stage liver disease. But not everyone who needs a new liver gets one. The system is strict—not because doctors want to say no, but because organs are scarce and every transplant must have the best chance of working.

Doctors use a scoring system called the MELD score, a numerical ranking based on blood tests that predicts short-term survival without a transplant to decide who gets priority. The higher your MELD score, the sicker you are, and the higher your place on the list. It’s not about how long you’ve been waiting—it’s about how urgently you need it. Your score comes from three lab values: bilirubin (liver function), creatinine (kidney function), and INR (blood clotting). If you’re on dialysis or have liver cancer that hasn’t spread, you might get extra points. But if you have other serious health problems—like heart disease, active infections, or uncontrolled cancer—you likely won’t qualify. It’s not just about the liver. Your whole body has to be strong enough to survive surgery and take a new organ.

Another big factor is abstinence from alcohol or drugs, a mandatory requirement for candidates with liver damage caused by substance use. Most centers require at least six months of sobriety, with proof from counseling or testing. This isn’t punishment—it’s survival. A transplant won’t fix the problem if you go right back to drinking. Same goes for smoking, obesity, or not following medical advice. If you can’t stick to a plan now, you won’t be able to handle the lifelong meds and checkups after transplant.

There’s also no room for secrecy. Doctors need your full medical history, mental health status, and support system. Do you have someone who can drive you to appointments? Help you take pills? Watch for warning signs? Transplant isn’t a solo mission. And yes, insurance or financial stability matters too. While the surgery itself might be covered, the lifelong anti-rejection drugs? Those cost thousands a month. If you can’t afford them, the team won’t put you on the list.

What you won’t see on the checklist? Age. There’s no upper limit—people in their 70s have had successful transplants. It’s about biological health, not birthday numbers. But if you’re over 65, expect more testing to make sure your heart and lungs can handle it. And if your liver damage came from hepatitis C, you’ll need to be cured first. New antiviral drugs make that possible for almost everyone now.

Below, you’ll find real-world comparisons and insights from people who’ve walked this path. Some posts break down how medications like statins or antibiotics affect transplant candidates. Others explain how herbal supplements might interfere with immunosuppressants. You’ll see how liver disease connects to other conditions—like osteoporosis from steroid use, or heart rhythm problems from drug interactions. This isn’t just a list of articles. It’s a practical toolkit for understanding what it really takes to qualify, what to watch out for, and how to prepare for what comes next.