Who can have a transplant for liver cancer?

A liver transplant is an operation to remove your liver and replace it with a healthy liver from a donor.

We have separate information if you are having part of your liver removed. Your doctor might call this a liver resection or a hepatectomy.

Who can have a liver transplant?

There are strict rules about who can have a liver transplant. These are called the eligibility criteria. You might be able to have a liver transplant if you have:  

• a single tumour no more than 5cm across
• a single tumour that is 5 to 7cm across and has not grown for at least 6 months  
• no more than 5 small tumours, each no larger than 3cm across  
• a level of alpha fetoprotein (AFP) less than 1000

You can't have a liver transplant if the cancer has grown into a blood vessel or spread outside of the liver. This is because there would be cancer cells left behind in your body after the operation. So the operation wouldn't remove all of the cancer.

You might not be able to have a liver transplant if you have severe scarring of the liver (cirrhosis). Your specialist decides whether you are well enough to cope with the operation and recovery period.

Assessment for a liver transplant

Before a transplant you have an assessment to check your liver and your general health. You usually have these tests as an outpatient but you may need a short stay in hospital.

The assessment might include:

• general blood tests such as liver function, blood type and tests for infections
• a blood test to check your level of AFP
• lung checks such as a chest x-ray
• heart checks like an electrocardiogram (ECG) or echocardiogram (ECHO)
• scans such as a CT scan and an MRI scan to look at your liver in detail
• fitness tests to check your general fitness ready for the surgery

Having a liver transplant involves careful preparation from a team of health care professionals. This is called the transplant team. You'll meet these people during the assessment. Take this time to ask as many questions as you want to. This helps you go into the operation feeling well prepared.

Once you have had the assessment, a team of specialists will decide if a liver transplant is suitable. If you and the transplant team agree that a transplant is the best treatment, your name goes on a waiting list for a donated liver.

Where do donor livers come from?

Most livers used for transplantation come from people on the organ donor registry. This is a list of people that have agreed to donate their organs when they die. It’s normal to have mixed feelings about this. Your transplant team will talk to you about it and can answer any questions to help put your mind at ease.

Living donors

Some people can have liver tissue donated from a living person, but this is rare. This is called a living donor liver transplantation. The donor gives part of their liver to you. Their liver can grow back quite quickly (rejuvenate).

A living donor liver transplant has risks for the donor, as well as the person receiving the liver tissue. Talk to your surgeon about whether this is a suitable option for you.

Waiting for a transplant

To have a liver transplant you need a donor liver that is a close match to your own. This means that the donor liver needs to be from someone with a similar weight and height, and a compatible blood type.

Coping with the wait

Unfortunately there are more people needing a transplant than there are livers available. Some people will only have to wait a few days. Other people have to wait longer, possibly many months. This waiting time can be extremely difficult for you and those close to you.

You may find yourself thinking about it all the time or worrying that it will never happen. There may be times when you are feeling unwell. Or wonder if you'll still be fit enough to have the transplant when a liver becomes available. Your transplant team are aware of this and will try to support you through it as much as they can. Talk to them if you are worried or feel unwell. 

Regular check ups and other treatments

You'll have regular tests and check ups at your local hospital while you are waiting for a transplant. But during this time the cancer can progress, which may mean you can't have a transplant anymore. 

To lower this risk you might have other treatments. The aim is to control the cancer while you are waiting. This treatment could include:

• heat treatment to destroy cancer cells (ablation)
• blocking off the blood supply to the cancer (TAE or TACE)

When a liver becomes available 

The transplant team will contact you immediately when a liver becomes available. They will examine the liver and collect information about the donor. They will discuss this with you, and check you are happy to go ahead with the transplant.

You should always have a bag packed ready to take into hospital. You'll need to get there very quickly once you have been contacted. 

Sometimes you arrive at the hospital and then the liver is found to be unsuitable for you. You will have to go home and wait until another liver is available. This can be frustrating, but your doctors and nurses will support you as much as they can.

NHS Blood and Transplant service

The NHS blood and transplant service have information about liver transplants. This includes details about waiting lists, the transplant procedure and life after a transplant.