[{"@context":"https:\/\/schema.org\/","@type":"Article","@id":"https:\/\/share-dev.upmc.com\/2026\/05\/liver-transplant-qa-alexander-miller\/#Article","mainEntityOfPage":"https:\/\/share-dev.upmc.com\/2026\/05\/liver-transplant-qa-alexander-miller\/","headline":"Liver Transplant Evaluation Process: Q&A with Alexander Miller, MD","name":"Liver Transplant Evaluation Process: Q&A with Alexander Miller, MD","description":"The first step of the liver transplant process is a liver transplant evaluation. This series of tests and meetings helps the transplant team decide if a liver transplant is an appropriate treatment option for you. Here, Alexander Miller, MD, UPMC Liver Transplant hepatologist, answers your questions about advanced liver disease and the liver transplant evaluation […]","datePublished":"2026-05-27","dateModified":"2026-05-27","author":{"@type":"Organization","@id":"https:\/\/www.upmc.com\/services\/transplant","name":"Transplant Services","url":"https:\/\/www.upmc.com\/services\/transplant","sameAs":"https:\/\/share-dev.upmc.com\/transplant-services\/","parentOrganization":"UPMC"},"publisher":{"@type":"Organization","name":"UPMC HealthBeat","logo":{"@type":"ImageObject","@id":"https:\/\/share-dev.upmc.com\/wp-content\/uploads\/2019\/04\/UPMC-HealthBeat-Logo.png","url":"https:\/\/share-dev.upmc.com\/wp-content\/uploads\/2019\/04\/UPMC-HealthBeat-Logo.png","width":600,"height":60}},"image":{"@type":"ImageObject","@id":"https:\/\/share-dev.upmc.com\/wp-content\/uploads\/2026\/05\/GettyImages-1496550974-e1779907736654.jpg","url":"https:\/\/share-dev.upmc.com\/wp-content\/uploads\/2026\/05\/GettyImages-1496550974-e1779907736654.jpg","height":866,"width":2000},"url":"https:\/\/share-dev.upmc.com\/2026\/05\/liver-transplant-qa-alexander-miller\/","about":["Health Topics A-Z","Liver Transplant","Transplant"],"wordCount":1204,"articleBody":"The first step of the liver transplant process is a liver transplant evaluation. This series of tests and meetings helps the transplant team decide if a liver transplant is an appropriate treatment option for you.Here, Alexander Miller, MD, UPMC Liver Transplant hepatologist, answers your questions about advanced liver disease and the liver transplant evaluation process.What Are the Symptoms of Advanced Liver Disease?There’s a big spectrum of liver disease, and not everyone has symptoms. For instance, someone may not know they have cirrhosis, which is severe liver scarring, until they receive a diagnosis.Other people have significant symptoms, such as:Ascites – Abdominal distension, when the abdominal cavity fills with fluid.Esophageal varices – Bleeding in the gastrointestinal (GI) tract.Hepatic encephalopathy – Mental fog or confusion.The criteria we use to assess how sick your liver is go beyond just symptoms. One person can have many issues from a symptoms standpoint, while someone else may only have significant lab (blood test) abnormalities. These can also indicate that their liver isn’t functioning well.What causes liver disease?A myth is that liver disease stems from one underlying problem, such as alcohol use. While common, alcohol is just one cause of chronic and acute liver diseases. Other common causes include viral infections, autoimmune conditions, and genetic diseases.Although acute and chronic liver diseases have many distinct causes, each with its own treatment approach, liver transplantation remains the only definitive\u00a0cure\u00a0for cirrhosis.What Is a Liver Transplant Evaluation?A liver transplant evaluation is a series of tests and meetings to determine if a liver transplant is a good treatment option for you.What happens during a liver transplant evaluation?When we first meet you, there’s a two- to three-day agenda of testing and appointments to go through.Before you come in, the transplant team reviews your labs, imaging, and clinical history from other providers. Then, you have a series of appointments to meet transplant surgeons and other important members of our transplant team, including:Behavioral health specialists.Medical hepatologists.Nutritionists.PharmacistsPhysical therapists.These appointments also involve medical testing, such as labs, to give us a clear idea of how your organs are functioning. We also do cardiac testing and, as appropriate, test other organ systems.You will also have age-appropriate cancer screenings, such as a colon cancer screening, pap smear, or mammogram. This ensures you’re not only healthy and fit before the liver transplant, but also after, when you’re on immunosuppressive medications.Do you need a referral for a liver transplant evaluation?Often, people receive a referral from either their primary care doctor or gastroenterologist. But a referral isn’t necessary. You can also call in and schedule an appointment to undergo evaluations on your own, without a referral.Do you need to bring a caregiver, also called a care partner, to your liver transplant evaluation?A liver transplant is such a huge process, with lots of testing, appointments, and new information. It’s important to have an ally, so identifying your caregiver as early as possible is key.Your care partner can help you follow up on appropriate questions throughout the process. During the critical time after your transplant, you’ll need them to help you with daily activities and follow-up appointments.What Happens After You Complete Your Liver Transplant Evaluation?After your evaluation, we take the information we gathered to our liver transplant candidacy selection meeting. There, we present your case, review your medical evaluation, and talk about your post-surgery support system.We also make sure that you don’t have any contraindications to transplantation. These are reasons why a transplant may not be a good idea or even harmful, such as an uncontrolled disease or unidentified cancer. If a couple of barriers need to be overcome, we make plans to address these factors.After the selection meeting, we’ll let you know if you’re:Approved for candidacy.Deferred to address a barrier.Not a candidate at this time.What Happens if You’re Not a Liver Transplant Candidate?If we don’t consider you to be a transplant candidate, that doesn’t mean “never.” It just means “not now.” Our attention shifts to treating more of your underlying chronic liver disease process and managing complications.So, for someone referred for transplant evaluation for hepatocellular carcinoma or perhaps colon cancer that has spread to the liver, we focus on other ways to address their cancer diagnosis. This may include a different surgical procedure, chemotherapies, immunotherapies, or radiation therapy.Everything we do is unique to each person’s liver disease. When someone’s not a transplant candidate, it just means our attention shifts toward more of the aggressive medical management.How often can you be evaluated for a liver transplant?There’s no set number of times you can undergo the evaluation. It’s an individualized process.What Happens if You\u2019re Approved for a Liver Transplant?When you’re approved for liver transplantation, we add you to the national transplant waiting list. Your place on the list primarily uses the Model for End-stage Liver Disease (MELD) score, but your blood type and different organ compatibilities are also taken into consideration.Then, there are two different pathways:Deceased donor transplant \u2014 You wait for a liver from a deceased donor. We notify you if an organ becomes available, and you come to our transplant center. If the organ is suitable and a good fit, you’ll have the transplant.Living donor transplant \u2014 A living donor is a healthy adult (friend, family member, or stranger) who freely chooses to donate part of their liver to someone with end-stage liver disease. If they’re an eligible living donor, we can schedule the living-donor liver transplant surgery at their convenience. This option removes the time component, and when someone has chronic or end-stage liver disease, time is of the essence.What is the MELD score?The MELD score is one of the scoring classifications we use specifically in the transplant world. It’s a collection of numbers, such as age, sex, and laboratory values, that gives us a score between 6 and 40. The higher the number, the more likely you are to receive a liver from a deceased donor when an organ becomes available.Of course, people are much more than just a number. So, it’s important to consider not only someone’s MELD score but also how they’re functioning and any symptoms that may bother them.What Happens Once You\u2019re on the National Transplant Waiting List?It’s not like you’re listed and then you lose contact with us. We’re constantly checking in with you. You get new lab checks, and we update your scores within the national transplant waiting list.How long are you on the national transplant waiting list?There’s no set amount of time for how long someone can be on the waiting list. Some people only spend a couple of weeks on the waiting list, while others wait months or even years.You can remain on the national transplant waiting list as long as you:Are healthy and fit enough to have a liver transplant.Have clear medical indications for transplantation.Sources"},{"@context":"https:\/\/schema.org\/","@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"name":"2026","item":"https:\/\/share-dev.upmc.com\/2026\/#breadcrumbitem"},{"@type":"ListItem","position":2,"name":"05","item":"https:\/\/share-dev.upmc.com\/2026\/\/05\/#breadcrumbitem"},{"@type":"ListItem","position":3,"name":"Liver Transplant Evaluation Process: Q&A with Alexander Miller, MD","item":"https:\/\/share-dev.upmc.com\/2026\/05\/liver-transplant-qa-alexander-miller\/#breadcrumbitem"}]}]