You probably don’t spend a lot of time thinking about your liver. It doesn’t growl like your stomach, wheeze like your lungs or itch like your skin. It goes along quietly doing its job: cleaning toxins out of your blood; making bile for digestion; metabolizing proteins, carbohydrates and fats; and hundreds of other essential activities.
But when your liver is in trouble, you can’t ignore it.
“If the liver isn’t functioning, a person can’t survive long,” says Oren Fix, MD, medical director of liver transplantation at UNC Hospitals.
The liver is one of the few organs that can regenerate. But sometimes, damage is so extensive that the only option for keeping a person alive is a liver transplant.
Read on to dispel some common misconceptions about liver transplants.
Myth No. 1: Liver disease is always caused by drinking too much alcohol.
“The common perception is that cirrhosis, or significant scarring of the liver, is only caused by alcohol,” Dr. Fix says. “While alcohol is a common cause of cirrhosis, it’s not the only one. Fatty liver disease caused by obesity, diabetes and the metabolic syndrome is a leading cause of liver disease.”
Hepatitis C, a virus that inflames the liver, is no longer the leading cause of liver disease in the United States, Dr. Fix says, because of recent advances in treatment.
Myth No. 2: Liver damage is always permanent.
The liver can regenerate. In other words, it can replace damaged tissues with new cells. Scar tissue from extreme damage (cirrhosis) may not heal and that is when a liver transplant may be necessary.
Myth No. 3: Liver cancer is incurable.
Liver cancer is another major reason why people need liver transplants.
“The liver is the only solid organ in the body that can be transplanted as a treatment for cancer,” Dr. Fix says.
According to the American Cancer Society, more than 42,000 people in the United States were diagnosed with liver or intrahepatic bile duct cancer in 2021. Liver cancer is the sixth-leading cause of cancer death in the United States and is predicted to become the third-leading cause by 2040.
Myth No. 4: Your liver is either functioning or it’s not.
Liver function isn’t black or white. There are many stages of liver disease, Dr. Fix says, including inflammation, scarring, severe scarring and liver failure. Because the liver is regenerative, it’s important to see your doctor as soon as you notice symptoms of liver disease.
These symptoms include:
- Jaundice (yellowing of skin or whites of the eyes).
- Ascites (swelling/retaining fluid in the abdomen).
- Confusion caused by a buildup of toxins in the body (difficulty paying attention, a reversal in the sleep/wake cycle and, eventually, significant confusion or even coma).
- Blood in vomit or a bloody or black, tarry stool.
“Any signs of a liver problem need to be evaluated right away,” Dr. Fix says.
Start with your primary physician, who may refer you to a gastroenterologist, who may then refer you to a transplant hepatologist for evaluation.
Myth No. 5: Only the elderly have liver disease.
Yes, chronic conditions of all types, including the liver, often become worse with age, Dr. Fix says. Cirrhosis may be worse in older people as chronic liver disease progresses. But congenital diseases of the liver are seen in infants, and certain diseases that affect the liver, such as Wilson disease, Alagille syndrome and autoimmune hepatitis, are usually diagnosed in children or young adults. Liver cancers can develop at any age.
Myth No. 6: You’re not eligible for a liver transplant until you’ve gone six months without an alcoholic drink.
It’s true that many transplant programs require people to refrain from alcohol for six months before a transplant. But at UNC Health and some other programs, the standard has more to do with how likely a patient is to stop drinking or participating in other activities that harm his or her liver. This could include overeating as well as alcoholism. That’s why patients are sometimes asked to lose weight before a transplant. Bariatric surgery may be recommended before, after or at the same time as a liver transplant.
“We look at factors that might predict a good outcome for the patient,” Dr. Fix says. “Sobriety is only one of those factors.”
Other factors include the patient’s caregiver support from family and friends, absence of other addictions and past successful counseling.
Providing resources for transplant patients who have experienced addiction is critical, before and after surgery. A transplant recipient’s team might include social workers, clinical psychologists, addiction specialists and other behavior-modification specialists.
Myth No. 7: If you might need a liver transplant, you should get on the waiting list as soon as possible.
Actually, time spent on the waiting list is not a major factor in deciding who gets a liver transplant, Dr. Fix says.
“The sickest people are first to get available livers,” he says. “It doesn’t matter much how long you’ve been on the waiting list. You don’t work your way up the list if your disease is stable.”
It is possible for a living person to donate part of his or her liver to a matching patient. “Both livers will regenerate quickly,” Dr. Fix says. However, the donor surgery is much riskier than the more common kidney donation, he says. Programs that offer living donor liver transplants are limited; at this time, UNC does not offer such a program. However, Dr. Fix says, he makes sure his patients are aware of the possibility.
If you have symptoms of liver disease, talk to your doctor as soon as possible. If you need a doctor, find one near you.