The liver synthesizes the proteins in blood which cause blood to clot. In general, if the child s overall health is not getting any worse, it is usually better to wait. But if they are not growing, or if they are having trouble with encephalopathy or ascites, and they are certain to continue to get sicker, they should be transplanted as soon as possible. It is always better to transplant before the child becomes very ill and needs an urgent graft. Urgent transplants always have worse success rates.
Some patients require transplantation even if their liver is functioning well.
Examples include patients with tumors that cannot be removed without removing the entire liver, and children with certain diseases of metabolism due to inherited diseases. Fortunately, most children get the livers they need before they become critically ill. LDLT can be scheduled before the child becomes so sick their chances for a successful transplant are diminished. However, LDLT is not always the best option. Different programs and doctors have different opinions regarding the issue of LDLT and the state of the art is constantly changing.