Liver transplant assessment (Liver transplantation assessment (work-up))
A series of tests and specialist reviews, usually over a few days, to decide whether a liver transplant is a safe and sensible option for you and whether you should go on the waiting list.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It is a detailed work-up (tests plus specialist reviews) to decide whether a liver transplant is safe and worthwhile for you, and whether to list you.
- Being assessed does not guarantee being listed, and being listed does not guarantee a transplant, because donor organs are limited.
- It looks at your whole health and your ability to cope with major surgery and lifelong medicines, not just your liver.
- In the UK this is an NHS service at designated transplant centres, not a private self-pay procedure.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Gives a clear, specialist answer on whether a transplant is a realistic and sensible option for you
People for whom a transplant would not be expected to improve survival or quality of life compared with not having one.
You move between tests and consultations, often over a couple of days. A transplant coordinator usually supports you throughout.
A named transplant coordinator as your point of contact throughout.
You move between tests and consultations, often over a couple of days. A transplant coordinator usually supports...
You may feel tired and emotionally drained. Most tests need no recovery, though you may be advised to rest after...
Your case is discussed at a multidisciplinary team meeting and a decision is made. The outcome and reasons are...
You join the transplant waiting list and are given advice on staying as well as possible, what to do if a donor...
What is a liver transplant assessment?
A liver transplant assessment is the detailed work-up done before anyone can be placed on the liver transplant waiting list. It uses many tests and reviews by different specialists to answer two questions: would a transplant help you live longer and better, and is your body able to cope with major surgery and lifelong medicines afterwards?
The assessment is carried out by a multidisciplinary team at a designated UK transplant centre. This usually includes liver surgeons, hepatologists (liver doctors), anaesthetists, intensive care specialists, transplant coordinators, a dietitian, a social worker, and often a psychiatrist or psychologist.
Being assessed does not mean you will definitely be listed, and being listed does not guarantee a transplant, because suitable donor organs are limited. The assessment is a careful, honest process of weighing up benefit and risk, not a formality.
In the UK, liver transplantation is an NHS service provided at a small number of specialist centres. It is not something you buy privately. A private specialist can help with your wider liver care and referral, but the transplant pathway itself runs through the NHS transplant service.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Liver and abdominal tests
Blood tests, ultrasound of the liver blood vessels, CT or MRI scans, and often an endoscopy to check for swollen veins in the gullet. These show the state of your liver and...
Heart and lung tests
ECG, echocardiogram (heart ultrasound), lung function tests, and sometimes a cardiopulmonary exercise test or coronary angiogram, to check you are fit enough for major...
Infection and general health screening
Blood tests for viruses (such as hepatitis and HTLV), kidney function, dental and other checks, to find anything that could cause problems during or after a transplant.
Psychological and social assessment
A discussion of how you cope, your support at home, any alcohol or drug use, and your ability to take medicines and attend appointments for life. This is part of judging...
Preparing for your test
- Expect to travel to a designated transplant centre and to be there for around two days, possibly staying overnight.
- Bring a full list of your medicines, including doses, and any recent blood test or scan results.
- Be ready to talk honestly about alcohol and drug use; accurate information helps the team plan the right care and support.
- Think about your support network at home, as the team will ask who can help you during recovery.
- Bring details of any other health conditions and the specialists who look after them.
- Write down your questions in advance, as you will meet several different professionals.
- Consider bringing a family member or friend for support and to help remember information.
What happens
Over the assessment, you move between different tests and meet several members of the team. You will have blood tests, scans of your liver and blood vessels, heart and lung checks, and often an endoscopy. A transplant coordinator usually guides you through the process and is your main point of contact.
You will also have a psychological and social assessment, which looks at how you cope, your home support, and your ability to manage lifelong medicines and appointments. If alcohol or drugs have affected your liver, the team will discuss this openly and may ask about a period of abstinence.
Afterwards, all the results are discussed at a multidisciplinary team meeting. The team weighs up whether a transplant would help you live longer and better, and whether your body can cope with the operation. The decision, and the reasons behind it, are then explained to you.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- People for whom a transplant would not be expected to improve survival or quality of life compared with not having one.
- People with other serious illnesses, such as untreatable cancer outside the liver or severe heart or lung disease, that make major surgery too dangerous.
- People with active, uncontrolled infection or other conditions that must be treated first.
- Situations where the team judges that lifelong medicines and follow-up could not realistically be managed, after support has been considered.
Delay or rearrange if…
- There is active infection or another unstable medical problem that needs treating first.
- A period of abstinence from alcohol or drugs has been recommended and is still in progress.
- Other health conditions (for example dental or heart problems) need attention before a decision.
- Important test results are missing or need repeating.
- Your support arrangements at home are not yet in place.
Alternatives to discuss
- Continued specialist management of your liver disease without transplant.
- Treating the underlying cause (such as hepatitis or alcohol-related liver disease) to see if your liver improves.
- Improving fitness and treating other conditions, then being reassessed.
- Supportive and palliative care, discussed honestly, where a transplant is not suitable.
- A second opinion at another transplant centre where appropriate.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Gives a clear, specialist answer on whether a transplant is a realistic and sensible option for you
- Identifies and treats other health problems that could affect surgery or recovery
- Connects you with a transplant team, coordinator, and support services
- Helps you understand the risks, benefits, and likely outcomes before any decision
- Can confirm the best plan even if that turns out not to be a transplant right now
Risks & complications
- Anxiety and emotional strain during a long and uncertain process
- Tiredness from several days of tests and travel to a specialist centre
- Having to discuss personal topics such as alcohol, drug use, and home circumstances
- Uncertainty while waiting for the team's decision
- Discomfort or minor complications from individual tests (for example bruising, or a sore throat after endoscopy)
- Finding other health problems that need treatment before any decision can be made
- Being told a transplant is not suitable right now, which can be distressing
- A complication from an invasive test, such as bleeding after endoscopy or a reaction to contrast dye
- Being assessed as not suitable for transplant at all, after full consideration
The hardest part for many people is the emotional uncertainty and the possibility of being told a transplant is not right for them now, or at all. The individual tests carry their own small risks. Ask the team what each test involves, how decisions are made, and what support is available whatever the outcome.
Published figures to discuss
There is no single success rate for an assessment, because its purpose is to make a decision rather than to treat. Outcomes after transplantation, and the chance of being listed, depend heavily on the underlying disease, other health problems, and national allocation rules. UK services consider whether a person is likely to have a reasonable chance of long-term survival, but individual figures should come from your own transplant team rather than from averages.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Death or deterioration while waiting for transplant | Clinically important and prioritised using severity scores and clinical urgency | Waiting-list risk depends on liver disease severity, cancer status, infections, kidney function and donor availability. | NHS Blood and Transplant — Liver transplant testsnhsbt.nhs.ukSource-linked context |
| Not being listed after assessment | A minority to substantial proportion depending on referral group | Reasons include improving disease, too-low expected benefit, active alcohol or substance issues, severe comorbidity, infection or cancer outside criteria. | NHS Blood and Transplant — Liver transplant testsnhsbt.nhs.ukSource-linked context |
| Major complications after transplant | Common enough to require lifelong specialist follow-up | Rejection, infection, kidney injury, diabetes, cardiovascular disease and cancer surveillance are part of long-term care. | NHS Blood and Transplant — Liver transplant testsnhsbt.nhs.ukSource-linked context |
| Lifelong immunosuppression | Expected after transplant | Medicines prevent rejection but increase infection and some cancer risks, so adherence and monitoring are essential. | NHS Blood and Transplant — Liver transplant testsnhsbt.nhs.ukSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
The assessment itself is not an operation, so there is no surgical recovery. What matters afterwards is understanding the decision, the plan, and the support available to you.
- Feeling emotionally tired after an intense few days
- Mild after-effects from individual tests, such as bruising or a sore throat
- A wait of days to weeks for the team's decision
- Mixed feelings whatever the outcome
- Needing time to take in a lot of information
Aftercare
- Make sure you understand the decision and the reasons behind it before you leave.
- Keep your transplant coordinator's contact details to hand for questions.
- Follow any goals you are given, such as treating other conditions, improving fitness, or staying abstinent from alcohol.
- Keep your contact details current so you can be reached quickly if listed.
- Look after the rest of your health, including dental care, vaccinations, and nutrition as advised.
- Use the support offered, including counselling, dietitian input, and patient groups.
- Tell the team promptly if your health changes while you wait.
- Transplant coordinator's contact details saved
- A clear understanding of the decision and next steps
- Any fitness, treatment, or abstinence goals written down
- Up-to-date medicine list
- Support arranged at home for the wait and for any future surgery
- Questions noted for your next contact with the team
⚠ Get urgent help if…
- Vomiting blood or passing black, tarry stools (seek urgent help)
- New or worsening confusion or marked drowsiness
- Rapidly increasing tummy swelling or breathlessness
- High fever or signs of serious infection
- Yellowing of the skin or eyes that is getting worse
- Any sudden, severe deterioration in how you feel while waiting
- Thoughts of harming yourself — seek urgent help and tell your team
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good outcome from the assessment is a clear, honest decision and a plan you understand. For some people this means being placed on the waiting list. For others it means being given goals to work towards before reassessment, or being told that a transplant is not the right option, with an explanation of why.
Being listed does not guarantee a transplant, because suitable donor organs are limited and are allocated according to national rules based on need and likely benefit. The assessment cannot promise a particular outcome; it is about making the safest, most sensible decision with the information available.
An assessment reflects your health at that time. If you are not listed now, you may be reassessed later if your situation changes. If you are listed, your condition is monitored while you wait, and your place on the list can change as your health or the national allocation picture changes. Plans are reviewed regularly rather than fixed.
Related tests, treatments or support
The assessment is part of your wider liver care. Alongside it, your team manages your liver disease and its complications, supports your nutrition and fitness, treats other conditions, and arranges any dental or infection checks needed before a possible transplant. These run together so you are as well prepared as possible.
Follow-up & long-term care
After the team meeting, the decision and reasons are explained to you, usually by a transplant doctor or coordinator. If you are listed, you have regular reviews while you wait. If you are not listed, you are given a clear plan, which may include reassessment. Make sure you know who your main contact is and how to reach them.
- Attend all review appointments while on the waiting list.
- Keep to any abstinence, fitness, or treatment goals you have agreed.
- Keep your contact details up to date so you can be reached urgently.
- Maintain dental health, vaccinations, and nutrition as advised.
- Tell your team promptly about any change in your health.
- Use the psychological and practical support offered to you and your family.
Repeat, follow-on and what comes next
- Some tests may need repeating, or extra tests added, before a decision can be made.
- A 'not yet' decision is common and may change after treatment, fitness, or abstinence goals are met.
- Being on the list is not fixed: your priority and suitability are reviewed as your health changes.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A named transplant coordinator as your point of contact throughout.
- A clear explanation of the decision and the reasons behind it.
- Psychological and dietetic support for you and your family.
- A defined plan for reassessment if you are not listed now.
- Regular review and clear emergency advice while you wait if you are listed.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- In the UK this is an NHS service, so the assessment is not generally a private self-pay procedure
- Any private liver consultations or scans done before referral
- Travel and accommodation costs to attend a specialist transplant centre
- Time off work for the assessment and follow-up appointments
- Costs of treating other conditions identified during the work-up
- Practical costs of arranging support at home for the wait and any future surgery
- If using private care before referral, the consultation and scan fees and what they include
- Confirmation that the transplant pathway itself runs through the NHS service
- What happens to your results and how they are shared with the transplant centre
- Who your main contact (coordinator) will be during the process
- What support is available if you are not listed or need reassessment
- How travel and time-off implications are explained to you
On the NHS? Liver transplantation in the UK is an NHS service at designated transplant centres; the assessment is part of that NHS pathway and is not a private self-pay procedure.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Assuming that being listed guarantees a transplant, when donor organs are limited.
- Not understanding why personal questions about alcohol, drugs, and home support are asked.
- Not being clear about the risks of individual tests such as endoscopy or contrast scans.
- Not knowing who your main contact is or how decisions will be communicated.
- Not discussing what support is available if the answer is no.
Marketing red flags
- Any private offer to 'arrange' a liver transplant outside the NHS system in the UK.
- Claims that paying privately will move you up an NHS transplant list.
- Promises of guaranteed listing or a guaranteed transplant.
- Overseas transplant offers that bypass proper assessment and ethical donor sourcing.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Would a transplant be expected to help me live longer and better, and by how much?
- What are the main things that could stop me being listed, and can any be improved?
- What does the psychological and social assessment involve, and how is it used?
- If I am listed, roughly how long might I wait, and how does the allocation system work?
- What support is available to me and my family during the wait?
- If I am not listed now, what would I need to do to be reassessed?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Can I have a liver transplant assessment done privately?
Does being assessed mean I will get a transplant?
Why do they ask about alcohol, drugs, and my home life?
What if alcohol caused my liver disease?
How long does the assessment take?
Can I get a second opinion if I am told no?
Are the tests painful or risky?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: British Liver Trust — Liver transplant assessment NHS Blood and Transplant — Liver transplant tests NHS Blood and Transplant — How doctors decide if you need a liver transplant NHS — Liver transplant: who can have one British Liver Trust — Information for family and carers
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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