End-Stage Liver Disease:
Guidelines for End-Stage Liver Disease & Related Disorders

THE PATIENT SHOULD MEET THE FOLLOWING CRITERIA:

• Life limiting condition.
• Pt/family informed condition is life limiting.
• Pt/family elected palliative care.
• Documentation of clinical progression of disease as evidenced by:
  • Serial physician assessment.
  • Inpatient hospitalizations.
  • Laboratory studies.
  • Radiologic or other studies.
  • Multiple Emergency Department visits.
• Dependence of 3 of 6 Activities of Daily Living.
  • Bathing.
  • Dressing.
  • Feeding.
  • Transfers.
  • Ambulation.
  • Continence of urine and stool.

PATIENT IS NOT A CANDIDATE FOR LIVER TRANSPLANTATION:

• Laboratory indicator of severely impaired liver function should show both:
  • Prothrombin time prolonged more than 5 sec. over control.
  • Serum albumin less than 2.5 gm/dl.

GENERAL INDICATORS:

• Ascites, persistent.
• Hepatorenal syndrome.
• Hepatic encephalopathy.
• Recurrent variceal bleeding.
• Spontaneous bacterial peritonitis.

SUPPORTING FACTORS:

• Progressive malnutrition and/or:
  • Muscle wasting with weakness.
  • Hepatitis B infection.
  • Continued active alcoholism.
  • Hepatitis C infection.
  • Hepatocellular carcinoma.

HOW WE HELP — END-STAGE LIVER DISEASE:

• Increased quality of life by managing symptoms.
• Pain management specifically to avoid exacerbation of encephalopathy.
• Coordination of care for comorbidities.
• Aggressively managing distressing symptoms to reduce hospitalizations.
• Nutritional support.
• Supporting the family with psychosocial and spiritual support including substance abuse issues.
• Education for the patient and family as disease progresses.