When to Refer for Liver Transplant: Child-Pugh and MELD Scoring

Donors are absolutely fine after a complete evaluation; the risk to life is now around 0.5%, and even that figure is based on older data, current donor safety protocols are stricter still. Donors are walking around and eating within two to three days, discharged by day six or seven, and most can travel home within about ten days to two to three weeks. They can resume office work and light household activity almost immediately; the only restriction is avoiding heavy weightlifting for three months, after which there are no restrictions at all.

There's no diet that prevents cirrhosis itself, prevention means treating the underlying cause: stopping alcohol, treating hepatitis B or C, and controlling diabetes and obesity. Once cirrhosis has developed, a high-protein, low-salt diet with frequent small protein-containing meals is recommended. On outcomes: large international studies show one-year survival of 85-90% and five-year survival over 70%, with emerging twenty-year data also showing around 70% survival, this is achievable when there is continuity of care. The shorter survival seen in some international patients usually reflects a lack of follow-up after they return home, working directly through local doctors and structured referral, not going straight through informal medical tourism, is what closes this gap.

Metabolic-associated fatty liver disease is rising because of uncontrolled diabetes, obesity and sedentary lifestyle, a pattern first seen in the US, where it became the leading transplant indication in 2024, and now increasingly in India too, even as hepatitis B and C become easier to control through treatment and vaccination. On lobe choice: there is no outcome difference between right and left lobe transplantation when the technique is sound, the choice simply reflects that adults need more liver mass (right lobe) while children need less (left lateral segment or left lobe). The only practical difference is for the donor, recovery from a left lobe donation is somewhat faster with slightly fewer complications, since less liver volume is removed.

Transplant recipients are on immunosuppression to protect the new liver, so even minor infections can escalate very quickly. The approach has to be to hit them early and hit them hard: get full blood work and cultures done immediately, look for a source of infection as fast as possible, and start empirical high-grade antibiotics well ahead of what a normal patient would need, often one or two steps more aggressive. Better collaboration between the treating team in India and the doctor in the patient's home country would meaningfully improve outcomes in these situations.

It is extremely cost-effective: a modest cost can buy 40-50 years of additional life for a patient dying of cirrhosis. Most complications and side effects happen in the first month after transplant; by one year, 80-85% of patients are doing well, patients who would not have survived at all without the transplant. Compared to a 57% one-year mortality without transplant in patients with bleeding and ascites, this represents a dramatic survival benefit, and outcomes are even more stark for patients with cancer, encephalopathy or severe sarcopenia, who have even poorer survival without it.

Child-Pugh class C (score 9+) is a definite indication; class B (7-9) is assessed case by case. A MELD score of 15 or above is the accepted threshold used internationally for transplant listing.

Refractory ascites unresponsive to diuretics, upper GI bleeding or haematemesis more than once, hepatic encephalopathy, and hepatorenal or hepatopulmonary syndrome.