Waiting for a Liver Transplant

Step Two: The Wait List Process and Preparing for Liver Transplant

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Liver transplantation can prolong and improve your quality of life, but waiting for a donor organ can be frustrating and stressful. The wait period for a liver transplant varies, but the median time to transplant for patients on Duke’s waitlist is much shorter than the national average. As you wait for surgery, you will meet regularly with doctors and other members of your transplant team to assess any progression of your liver disease and provide you with the resources you need to stay healthy. 

Ready for an Evaluation?

If you are interested in making an appointment for an evaluation, please ask the provider treating your liver disease to submit a referral.

The Liver Transplant Wait List Process

If you are a candidate for liver transplantation, you will be listed in the national database maintained by the United Network for Organ Sharing (UNOS). UNOS wait times are based on many factors, including blood type, the size of the donor’s liver, body size, geographical distance from the donor, and your MELD (Model for End-Stage Liver Disease) score.

What Does My MELD Score Mean?
The score is based on blood tests that measure:

  • Kidney function (creatinine)
  • Liver function (bilirubin)
  • Blood clotting time (international normalized ratio or INR)
  • Sodium level 

MELD scores range from 6 to 40; the higher the score, the greater your need for a liver and the higher your place on the waitlist. When a donor liver becomes available, it is offered to the sickest person on the list who matches the donor’s characteristics like body size and blood type and is geographically closest to the donor. If the liver is not a good match for that person, it is offered to the next person on the list until it is accepted. 

In July 2023, MELD 3.0 added current sex and albumin levels to the MELD score calculation. MELD 3.0 is shown to better predict who needs a liver transplant first and addresses disparities between men and women.

Reducing Your Wait Time for a Liver Transplant

The liver is a regenerative organ, meaning that if it is healthy, it can regrow. This capability creates alternatives to traditional liver transplantation, including split liver and living donor transplants. Your doctor or transplant coordinator can talk to you about these options after you are listed for transplant.

Split Liver Transplant

We’re one of the few liver transplant hospitals to divide a healthy liver from one donor between two patients -- typically an adult and a child. These split liver transplants can shorten your wait for a donor liver and allow us to save two lives rather than one.

Living Liver Donation 

In a living donation, part of the liver of a healthy adult donor is removed and transplanted into the person with liver disease. Donors must be in excellent health to donate. 

Consistently Ranked Among the Nation’s Best Hospitals

Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are once again recognized as the best hospital in North Carolina, and nationally ranked in 11 adult and 10 pediatric specialties by U.S. News & World Report for 2024–2025.

Staying Healthy

As a candidate for a liver transplant, you have a responsibility to stay as healthy as possible before and after surgery. This means eating properly, exercising regularly, quitting smoking, abstaining from alcohol, taking your medications as prescribed, and keeping appointments with your transplant team. We have a zero-tolerance policy for alcohol, nicotine, and drug use and may randomly screen you for these substances. Establishing healthy habits before surgery will also help you as you recover and in your life after transplantation.

Be Prepared for the Call

While you are waiting for a donor liver, your transplant coordinator must be able to reach you at all times. The social worker will help you and your caregiver create a reliable plan for getting to the hospital on short notice. When you receive the call that a donor liver has been matched to you, you will be told when to arrive at the hospital.  


Step 3: Transplant Surgery

This page was medically reviewed on 06/08/2023 by