Transplant Selection: Disease Severity and Psychosocial Evaluation

The psychosocial evaluation for liver transplant candidates with alcohol-associated liver disease (ALD) has evolved dramatically. The evaluation process has evolved from a stringent 6-month abstinence rule to robust, evidence-based assessment protocols incorporating disease severity scores, structured alcohol use assessments, biomarker testing, psychiatric evaluation, and validated risk prediction tools. These comprehensive evaluations aim to decrease rates of return to alcohol use and improve post-transplant patient and graft survival. We advocate for standardized, nonstigmatizing approaches to patient selection that balance responsible organ stewardship with recognition of ALD as a chronic, treatable condition.