Younger patients in the UK are waiting significantly longer for liver transplants than older individuals, according to NHS data. The current allocation system, which uses a computer algorithm to prioritise those most likely to die soon, has widened the gap, with 26 to 39-year-olds now waiting an average of 156 days longer than patients over 60.
The algorithm, introduced in 2018 to reduce deaths on the waiting list, assesses 21 recipient parameters—including age, disease type, and severity—along with seven donor factors. Higher scores indicate greater urgency, which often favours older patients. Before the algorithm, younger patients waited about 40 days longer; now the disparity has nearly quadrupled.
Sarah Meredith, 31, has been on the transplant list since July 2021 due to a rare complication from cystic fibrosis. She moved from Devon to Cambridge to be closer to the hospital, but has yet to receive a call. “What concerns me the most is having my family watch me slowly die,” she said. “Some days it's really quite dark.”
Liver transplant surgeon Prof Nigel Heaton expressed concern that younger patients, who often have congenital or early-onset liver disease, are deteriorating while waiting. “They're not going to die immediately, but you can see they're deteriorating… This jeopardises their chances of a successful transplant,” he said, calling for a system tweak to give younger patients equal opportunity.
Olive McGowan, chief nurse for NHS Blood and Transplant, acknowledged the stress but defended the algorithm, stating: “What we must do is prevent patients from dying on the liver transplant waiting list. So we maximise this very precious gift and transplant those who are most in need.” Krishna Menon, president of the British Transplantation Society, noted the algorithm is constantly monitored and can be changed.
