Striking the Right Note: Assessing the Recipient for Liver Transplantation in Low- and Middle-Income Countries

More than 50 years have passed since Starzl et al. did the first liver transplant. Since then the transplant speciality has witnessed enormous growth and at present more than 1 000 000 liver transplants have been performed to date in over 100 liver transplant centers around the world. In Europe and North America, the predominant mode is deceased donor liver transplantation, while in Turkey and most of the Asian countries, the living donor liver transplant or split liver transplantation is the most widely available method for liver transplantation. The etiology of end-stage liver disease is also different in developed and developing countries. Liver recipients usually have multiple comorbidities and in addition, derangements in liver functions also indirectly affect other systems. The anaesthesiologist plays a very crucial role as a perioperative physician concerning liver transplantation. He is the lead person involved, from preoperative workup to intraoperative management and postoperative care in critical care units. Anaesthesiologists are also actively involved in developing organ transplant pathways and protocols for perioperative assessments. Although there are local protocols and pathways for assessing liver transplant recipients, there is a lack of standardization in the literature for such assessments. This article highlights essential aspects in assessing liver transplant recipients and the role of some specific assessment tools and establishes a standardized protocol for selecting and optimizing suitable patients, thereby reducing the mortality and morbidity associated with this major surgery.