Referral to the Liver Transplant Center

End-stage liver disease (ESLD) is a burden pathology worldwide and represents the 11th cause of death worldwide. Unlike other terminal illnesses, ESLD with or without hepatocellular carcinoma can be definitively treated with liver transplantation (LT). Even if the LT is the optimal therapy for ESLD, the accessibility to LT depends on four key steps: (1) referral from other hospitals or outpatient specialists or family physicians to an LT center; (2) pretransplant evaluation in the LT center; (3) patient management during the waiting list; (4) organ allocation. The last three steps are regulated by international and national guidelines, and equity is guaranteed from national transplant organizations. The referral process of potential LT candidates, instead, is not well regulated and depends on the initiative of each referring physician. The few available data regarding referral rates for LT show the lack of an equal access to evaluation by the LT centers, often because of subjective and/or nonmedical factors. The aim of this chapter is to clarify the guidelines for adult patient referral to LT centers, helping the family physician and specialists in local hospitals and outpatient services in the ESLD management and timed LT referral, in order to guarantee the same opportunities to all potential LT candidates.