The last 10 years have witnessed a number of changes in the liver transplant process. Key among these changes are the longer preservation times allowed with UW solution, the development of the new techniques for the transplantation of pediatric patients, and the reintroduction of xenotransplantation for both permanent and temporary hepatic support. Early referral and prompt transplant of patients are among the most important keys to successful transplantation. However, owing to the present organ allocation system and the lack of suitable organ donors, potential liver transplant recipients will continue to experience a significant mortality rate on the waiting list. In addition, owing to the long waiting times for suitable donor organs, many patients who would have been excellent low-risk candidates will deteriorate as their liver disease progresses and become high-risk patients for liver transplantation. Expanding the donor pool and modifying the present liver allocation system to shift the flow of organs to the better-risk patients will do more to improve the results of liver transplantation than any other change in the management and transplantation of patients with severe liver disease.
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