Understanding Liver Transplant Numbers Around the World

Liver transplantation has become an established medical procedure worldwide, with thousands of operations performed each year. In the United States alone, about 8,200 liver transplants took place in 2018, involving both adults and children. Of these procedures, approximately 390 came from living donors who donated part of their liver to help a family member or friend in need.^[1] By 2023, the number of transplants had grown to more than 10,000 in the United States, showing how this procedure has expanded over time.^[4]

In 2015, around 7,100 liver transplants were carried out in the United States, with nearly 600 of these performed on patients who were 17 years old or younger.^[3] These numbers highlight that liver transplantation is not limited to adults but is also an important option for children and teenagers facing serious liver problems. The procedure has become the third most common type of organ donation in the country, reflecting its crucial role in saving lives.^[4]

Despite these encouraging figures, the demand for liver transplants far exceeds the supply of available organs. In 2018, while thousands of transplants were performed, approximately 12,800 people were registered on the national waiting list, hoping to receive a transplant.^[1] This gap between need and availability means that many patients must wait months or even years for a suitable donor liver to become available. Each week, between 200 and more than 300 people join the liver transplant waiting list, adding to the growing number of individuals hoping for this lifesaving procedure.^[4]

What Causes the Need for a Liver Transplant

People require a liver transplant when their liver stops functioning properly, a condition called liver failure. The liver is the largest internal organ in your body and performs many essential jobs, including processing nutrients and medications, producing bile (a substance that helps digest fats), making proteins that help blood clot, removing toxins and bacteria from the blood, and supporting the immune system.^[1] When the liver can no longer carry out these tasks, a person’s life is at serious risk, and transplantation may be the only solution.

For adults in the United States, the most common reasons for needing a liver transplant include alcoholic liver disease, cancers that start in the liver combined with cirrhosis (scarring of the liver), fatty liver disease known as nonalcoholic steatohepatitis, and cirrhosis caused by chronic hepatitis C.^[3] These conditions typically develop over time as repeated damage to the liver causes healthy tissue to be replaced by scar tissue, eventually leading to complete liver failure.^[11]

In children, the most frequent cause requiring a liver transplant is biliary atresia, a condition where the bile ducts are blocked or absent.^[3] Doctors may also consider liver transplantation for rare inherited disorders such as urea cycle disorders and familial hypercholesterolemia, where the liver cannot properly process certain substances in the body.^[3]

Another category of liver failure is acute liver failure, which occurs when a previously healthy liver suddenly stops working. This uncommon but serious condition is most often caused by taking too much acetaminophen, a common pain reliever found in many over-the-counter medications.^[3] Other causes of acute liver failure include bad reactions to prescription medicines, illegal drugs, herbal medicines, viral hepatitis, toxins, blockage of blood vessels to the liver, autoimmune diseases, and genetic disorders.^[3] People with acute liver failure receive priority placement on the transplant waiting list because their condition develops so rapidly and is immediately life-threatening.^[4]

Who Is at Higher Risk of Needing a Transplant

Several groups of people face a higher risk of developing liver disease severe enough to require transplantation. Understanding these risk factors can help individuals and healthcare providers identify problems early and potentially slow the progression of liver damage before transplantation becomes necessary.

People who consume alcohol heavily over many years are at significant risk for developing alcoholic liver disease, which is one of the leading causes of liver transplants. As the liver works to process alcohol, repeated exposure causes inflammation and scarring that accumulates over time. Similarly, individuals with chronic viral hepatitis B or C infections face increased risk because these viruses directly attack liver cells, causing ongoing damage that can progress to cirrhosis and liver failure.^[3]

Those with metabolic conditions affecting the liver also have higher risk. Fatty liver disease, particularly nonalcoholic steatohepatitis, occurs when fat builds up in the liver even without heavy alcohol use. This condition has become increasingly common and is often linked to obesity, diabetes, and high cholesterol.^[3] People with certain inherited genetic disorders that affect liver function from birth are also at risk and may need transplantation at a young age.

Individuals who develop liver cancer, especially hepatocellular carcinoma (a type of cancer that starts in liver cells), may become transplant candidates if the cancer has not spread beyond the liver.^[4] The presence of other cancers that have spread to the liver from elsewhere in the body, such as metastatic colorectal cancer or certain neuroendocrine tumors, may also make someone eligible for transplant evaluation, though specific criteria must be met.^[4]

Common Signs That Liver Transplant May Be Needed

As liver disease progresses toward failure, patients experience a range of symptoms that significantly affect their daily lives. These symptoms develop because the liver can no longer perform its essential functions properly. Recognizing these signs is important because they indicate the liver is failing and medical evaluation is urgently needed.

One of the most common symptoms is ascites, which is the buildup of fluid in the abdomen. This causes the belly to swell and become uncomfortable, and some people need to have this fluid drained with a needle procedure called paracentesis, sometimes as often as once or twice a week.^[17] The fluid accumulation happens because the damaged liver cannot produce enough proteins to keep fluid in the blood vessels, and increased pressure in the liver’s blood vessels forces fluid out into the abdominal cavity.

Another serious symptom is hepatic encephalopathy, which occurs when the damaged liver cannot remove toxins from the blood, allowing these harmful substances to affect the brain. People with this condition may experience forgetfulness, confusion about where they are or who people are, slowed thinking, poor judgment, changes in personality or behavior, altered sleep patterns, a musty or sweet odor on the breath, shaking hands, slurred speech, and sluggish movements.^[17] The severity of these symptoms depends on how badly the liver is damaged and how much toxin buildup occurs in the body.

Many patients develop yellowing of the skin and the whites of the eyes, a condition called jaundice, along with dark-colored urine and light-colored stools.^[15] This happens because the liver cannot properly process bilirubin, a yellow substance produced when old red blood cells break down. Other common symptoms include feeling extremely tired, pain or tenderness in the area over the liver, and fever when infections develop.^[15] Some people also experience intense itching of the skin, bleeding problems because the liver cannot make clotting proteins, and swelling in the legs and feet.

How to Lower the Risk of Liver Disease

While some causes of liver disease cannot be prevented, such as inherited genetic conditions, many steps can be taken to protect liver health and reduce the likelihood of developing liver failure. Prevention strategies focus on avoiding substances and behaviors that damage the liver, as well as managing conditions that put the liver at risk.

Limiting or avoiding alcohol consumption is one of the most important protective measures. Heavy, long-term alcohol use is a leading cause of liver damage and transplant need. People who already have liver disease from any cause should avoid alcohol completely, as it accelerates liver damage regardless of the underlying condition. Similarly, avoiding illegal drugs and using medications only as prescribed helps protect the liver from toxic injury.

Getting vaccinated against hepatitis A and hepatitis B provides important protection against viral liver infections. While there is currently no vaccine for hepatitis C, avoiding behaviors that spread this virus, such as sharing needles or other drug equipment, is crucial. People at risk for hepatitis C should consider getting tested, as early detection and treatment can prevent progression to severe liver disease.

Maintaining a healthy weight through balanced eating and regular physical activity helps prevent fatty liver disease. This is increasingly important as obesity-related liver disease becomes more common. Managing conditions like diabetes, high cholesterol, and high blood pressure also protects the liver because these conditions can contribute to liver damage over time.

Being cautious with medications is essential because many drugs are processed by the liver. Taking more than the recommended dose of acetaminophen is a leading cause of acute liver failure. People should always follow dosing instructions, be aware that acetaminophen is found in many combination products, and consult healthcare providers before taking new medications or supplements, including herbal products, which can sometimes cause unexpected liver damage.

How Liver Failure Changes Normal Body Functions

Understanding what happens in the body when the liver fails helps explain why transplantation becomes necessary. The liver performs so many critical tasks that when it stops working, multiple body systems are affected, creating a cascade of serious health problems.

The liver normally filters blood coming from the digestive system before it circulates to the rest of the body, removing bacteria, toxins, and waste products. When the liver fails, these harmful substances remain in the bloodstream and can damage the brain, causing hepatic encephalopathy with its cognitive and neurological symptoms.^[17] The buildup of toxins also affects other organs and contributes to the overall feeling of illness that patients experience.

A failing liver cannot produce adequate amounts of proteins needed for blood clotting, leading to easy bruising and bleeding problems. This can make even minor injuries potentially dangerous and complicates medical procedures. The liver also cannot produce enough albumin, an important protein that helps keep fluid inside blood vessels. Without sufficient albumin, fluid leaks out into the abdomen causing ascites, and into the legs causing swelling.^[14]

The damaged liver develops increased resistance to blood flow, creating a condition called portal hypertension where pressure builds up in the blood vessels that carry blood to the liver. This high pressure forces blood to find alternate routes, creating enlarged, fragile blood vessels called varices, especially in the esophagus and stomach. These varices can rupture and cause life-threatening bleeding.^[14]

Bile production and flow become disrupted in liver failure. Since bile is necessary for absorbing fats and fat-soluble vitamins, people with liver failure may develop nutritional deficiencies even if they eat adequately. The inability to excrete bilirubin causes jaundice and can contribute to severe itching that significantly impacts quality of life.

The liver’s role in regulating blood sugar, processing medications, and supporting immune function all become impaired. This makes people with liver failure more susceptible to infections, less able to fight off illness, and at risk for dangerous reactions to medications that accumulate in the body rather than being properly broken down and eliminated. In advanced stages, kidney function may also fail, a complication called hepatorenal syndrome, where the failing liver causes the kidneys to stop working even though they are not directly diseased.^[14]