Adult Liver Transplant Candidate Evaluation: What the New AASLD/AST Guideline Changes

Introduction and Context

Liver transplantation is one of the most effective life-saving treatments in modern medicine, but it is also one of the most resource-limited. Because donor organs are scarce, the central question is not simply who might benefit from transplant, but who is most likely to benefit enough to justify allocation of a national resource. The 2025 AASLD/AST Practice Guideline on adult liver transplantation candidate evaluation was issued to provide a modern, structured framework for this decision-making process.

This guideline matters because the candidate-evaluation process has become more complex. Adult liver transplant recipients are older, have more comorbidities, and are more likely to present with multifactorial illness, including metabolic dysfunction-associated steatotic liver disease, alcohol-associated liver disease, viral hepatitis, and hepatocellular carcinoma. At the same time, transplant systems must balance benefit, justice, and equity, while avoiding both over-restriction and inappropriate listing. The updated guideline aims to standardize evaluation, reduce unwarranted variation across centers, and help teams identify both medical indications and barriers to successful outcomes.