Table 1 Current UK Blood and Transplant criteria for registration as a super-urgent transplant; registered at UK Transplant, donor livers available from whole national pool
Category 1: Aetiology: Paracetamol poisoning: pH<7.25 more than 24 h after overdose and after fluid resuscitation
Category 2: Aetiology: Paracetamol poisoning: Co-existing prothombin time >100 s or INR >6.5, and serum creatinine >300 μmol/l or anuria, and grade 3–4 encephalopathy
Category 3: Aetiology: Paracetamol poisoning: Serum lactate more than 24 h after overdose >3.5 mmol/l on admission or >3.0 mmol/l after fluid resuscitation
Category 4: Aetiology: Paracetamol poisoning: Two of the three criteria from category 2 with clinical evidence of deterioration (e.g. increased ICP, Fio2>50%, increasing inotrope requirements) in the absence of clinical sepsis
Category 5: Aetiology: Seronegative hepatitis, hepatitis A, hepatitis B, or an idiosyncratic drug reaction. Prothrombin time >100 seconds or INR >6.5, and any grade of encephalopathy
Category 6: Aetiology: Seronegative hepatitis, hepatitis A or hepatitis B or an idiosyncratic drug reaction. Any grade of encephalopathy, and any three from the following: unfavourable aetiology (idiosyncratic drug reaction, seronegative hepatitis), age >40 years, jaundice to encephalopathy time >7 days, serum bilirubin >300 μmol/l, prothrombin time >50 s or INR >3.5
Category 7: Aetiology: Acute presentation of Wilson’s disease, or Budd–Chiari syndrome. A combination of coagulopathy, and any grade of encephalopathy
Category 8: Hepatic artery thrombosis on days 0 to 21 after liver transplantation
Category 9: Early graft dysfunction on days 0 to 7 after liver transplantation with at least two of the following: AST >10 000 IU/l, INR>3.0, serum lactate >3 mmol/l, absence of bile production
Category 10: Any patient who has been a live liver donor who develops severe liver failure within 4 weeks of the donor operation.
  • ICP, intracranial pressure; Fio2, inspired oxygen concentration; INR, international normalised ratio.