The liver is your largest internal organ. An adult’s weighs about 3 pounds. It’s just below your diaphragm on the right side of your belly. Your liver does many important things, including making proteins and breaking down nutrients from food to help your body make energy.

You might need a transplant if your liver doesn’t work the way it should. This is called liver failure.

Liver failure can happen suddenly as a result of viral hepatitis, drug-induced injury, or infection. This is called acute or fulminant hepatic failure.

It can also be the end result of a long-term problem (chronic). Conditions that can cause chronic liver failure include:

Chronic hepatitis with cirrhosis
Primary biliary cholangitis, a rare condition in which your immune system destroys your bile ducts
Sclerosing cholangitis, scarring and narrowing of the bile ducts inside and outside your liver, causing bile to back up
Biliary atresia, a rare liver disease that affects newborns
Alcohol overuse
Liver cancers such as hepatocellular carcinoma
Wilson’s disease, which causes unusual levels of copper throughout your body, including in your liver
Hemochromatosis, in which your body has too much iron
Alpha-1 antitrypsin deficiency, an unusual buildup of a protein called alpha-1 antitrypsin in your liver, resulting in cirrhosis

Your doctor may recommend a liver transplant if they’ve ruled out all other treatments for your condition and if they think you’re healthy enough for surgery. They’ll refer you to a transplant center. There, you’ll talk with specialists and have tests to find out whether you can get a transplant.

Each center has different rules about who can have a transplant. You might not be able to get one if you have:

A severe infection
Problems with alcohol or drug use
Cancer outside your liver
Serious heart or lung disease
You or your caregivers will also need to understand and follow your doctor’s directions after the surgery, including medications that you’ll take for the rest of your life.

A team of specialists will help you every step of the way. They include:

A liver specialist (called a hepatologist)
A transplant surgeon
A transplant coordinator, usually a registered nurse who specializes in the care of liver transplant patients. This person will be your main contact with the transplant team.
A social worker to discuss your support network of family and friends, employment, and financial needs
A psychiatrist to help you deal with issues that might come along with a transplant, such as anxiety and depression
An anesthesiologist
A chemical dependency specialist to help if you have a history of alcohol or drug use
A financial counselor to act as a go-between for you and your insurance company

Bring all medical records, X-rays, liver biopsy slides, and a record of your medications to your evaluation for a liver transplant. The team might do tests including:

CT, which uses X-rays and a computer to make pictures of your liver. CTs and chest X-rays will also check your heart and lungs.
Doppler ultrasound to find out whether the blood vessels to and from your liver are open
Echocardiogram to check your heart 
Pulmonary function studies to look at how well your lungs exchange oxygen and carbon dioxide
Blood tests to learn more about your blood and to check how well your liver is working. You’ll also be screened for HIV, other viruses (such as herpes and Epstein-Barr), and hepatitis.

If you meet the criteria for a transplant but don’t have a donor lined up, the center will put you on a waiting list. It lists patients according to their blood type, body size, and medical condition (how ill they are). Each patient is given a priority score based on three blood tests (creatinine, bilirubin, and INR). The score is known as MELD (model of end-stage liver disease) in adults and PELD (pediatric end-stage liver disease) in children.

Patients who have the highest scores and acute liver failure get top priority for a liver transplant. If their condition gets worse, their scores rise, and their priority for transplant goes up. This way, the transplants go to people who need them the most.

It’s hard to say how long you might have to wait to get a liver. Your transplant coordinator is always available to discuss where you are on the waiting list.

You might get a liver from a donor who’s alive or one who’s died.

Living donor

In a living donor liver transplant, your doctor will take part of a healthy person’s liver and implant it in you. Both liver segments will grow back to their regular size in a few weeks.

Deceased donor

A donor who’s died may have had an accident or head injury. Their heart is still beating, but they’re legally dead because their brain has stopped working permanently. The donor is usually in an intensive-care unit. The team turns off life support in the operating room during the transplant.

The donor’s identity and the details of their death are confidential.

Depending on your condition, you might have a “domino” liver transplant. This is when a young person who has a metabolic liver disease gets a liver from a healthy donor. But rather than destroying the young person’s liver, doctors give it to an older patient who has a more diseased liver. It can take decades for the older person to have signs of the metabolic disease. Or they may never get it at all. Domino transplants help widen the pool of people who can donate organs.

A living donor may be a relative, a spouse, a friend, or an unrelated “Good Samaritan.” They’ll have complete medical and psychological tests to keep risks as low as possible. Blood type and body size are crucial to finding a match. A donor younger than 60 years old is ideal.

Hospitals will check possible donors for liver problems or other things, including:

Liver disease
Overuse of alcohol or drugs
Cancer
Infections
Hepatitis
HIV

A transplant coordinator will contact you when they’ve found a possible donor liver. Don’t eat or drink anything after they tell you to go to the hospital. When you get there, you’ll probably have more blood tests, an electrocardiogram, and a chest X-ray. You also may meet with the anesthesiologist and a surgeon. If the donor liver is approved, the transplant will go ahead. If not, you’ll go home.