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CION Cancer Clinics
The transplant assessment: every test you will have | CION Cancer Clinics
A liver transplant assessment checks that the cancer is still within transplant limits, that your body can survive a very large operation, and that you have support to recover. Expect blood tests, fresh liver scans, heart and lung tests, an endoscopy, infection checks and meetings with a dietitian, psychologist and social worker. This page lists each test and why it is done. At CION Cancer Clinics, a multidisciplinary tumour board weighs your liver function and your scans before recommending any treatment.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed October 2026, next review due October 2027
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On this page
- What tests are done before a liver transplant?
- Which tests will I have, and what is each one for?
- What happens during the transplant assessment?
- What do the words in the assessment mean?
- Who does the transplant assessment not apply to?
- What this page cannot tell you
- Common questions about the transplant assessment
The short answer
What tests are done before a liver transplant?
A transplant assessment checks three things: that the cancer is still within the limits for a transplant, that your liver and the rest of your body can survive a very large operation, and that you have the support to recover. It usually means blood tests, liver scans, heart and lung tests, an endoscopy, infection checks, and meetings with a dietitian, a psychologist and a social worker.
This page is for people with hepatocellular carcinoma (HCC), the cancer that starts in the liver itself, who have been referred for a transplant. Cancer that spread to the liver from elsewhere is not treated with a transplant. If you are not sure which you have, read primary versus secondary liver cancer first.
Why it is so thorough
A liver transplant is one of the largest operations in medicine, and in India most new livers come from a living family member who takes a real risk to donate. Every test exists to make sure that risk and that operation are likely to help you. Nobody is testing whether you deserve a transplant.
The assessment is done by the transplant centre and its partners. CION coordinates the referral and keeps your cancer treatment on track while it happens.The full list
Which tests will I have, and what is each one for?
The exact list differs between transplant centres. These are the groups almost everyone goes through.
Blood tests
These measure how well the liver, kidneys and clotting are working, and give the MELD score used to judge how unwell the liver is.
- Liver function tests, bilirubin, albumin and INR
- Kidney tests and salts
- Blood group, for matching a donor
- AFP, a marker some liver cancers release
- Hepatitis B, hepatitis C and HIV status
Scans of the cancer
A fresh triple-phase CT or MRI counts and measures every tumour and checks the blood vessels. A CT of the chest, and sometimes a bone scan or PET-CT, looks for spread outside the liver that would rule a transplant out.
Heart and lungs
An ECG and an echocardiogram (a heart ultrasound) are standard. Many people also have a stress test, breathing tests and a chest X-ray. Cirrhosis can affect blood pressure in the lungs, so the echo is read with that in mind.
Endoscopy and other checks
- An endoscopy to look for varices, swollen veins in the food pipe
- Screening for TB and other infections that could flare after transplant
- A dental check, since mouth infections matter on anti-rejection medicines
- Age-appropriate checks for other cancers
Not sure whether this applies to you?
Ask an oncologistHow it runs
What happens during the transplant assessment?
Referral with your records
Your oncologist or hepatologist sends your scans, reports and treatment history to the transplant centre. Bring the actual scan discs, not only the written reports.
First transplant clinic
A transplant surgeon and hepatologist review your history and decide whether a full assessment is worth doing now. Some people are first sent back for downstaging treatment.
The test block
The tests are often grouped into a few intense days, sometimes with a short hospital stay. Families travelling from districts should plan to stay in Hyderabad for that stretch.
Meetings with the wider team
A dietitian checks muscle and nutrition. An anaesthetist reviews fitness for surgery. A psychologist and social worker talk with you and your family about support, medicines and, where relevant, alcohol.
The transplant meeting decides
All the results are discussed together. You are told whether you are accepted, need more tests, or are not suitable, and why.
On your reports
What do the words in the assessment mean?
- MELD score
- A number worked out from bilirubin, INR, kidney function and salt levels. It shows how unwell the liver is. See the MELD score explained.
- Milan criteria
- The size and number limits most teams use for transplanting liver cancer: one tumour no bigger than a lemon, or up to three small ones, with no spread into large vessels.
- Portal vein
- The main vein carrying blood into the liver. Cancer growing into it usually rules a transplant out.
- Hepatopulmonary syndrome
- A lung problem caused by cirrhosis, which lowers oxygen levels. A bubble test during the echo looks for it.
- Sarcopenia
- Loss of muscle. It matters for recovery, and is often improved before surgery with protein and activity, not by cutting food.
- Authorisation committee
- For a living donor, Indian law requires a committee to review the paperwork and confirm that donation is voluntary and unpaid.
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Did you know
Families often cut protein for someone with cirrhosis, fearing it will cause confusion. In most cases the opposite is needed. Transplant teams want enough protein and muscle before surgery, and the dietitian at the assessment will tell you what to eat.
Not everyone
Who does the transplant assessment not apply to?
It does not apply to people whose cancer has spread outside the liver, has grown into the main blood vessels, or sits well beyond the transplant limits without a plan to shrink it. It also does not apply to people too unwell for any major operation. For them, the assessment would only add delay and travel. Read more on who is not eligible for a transplant.
The donor has a separate assessment
A family member who offers to donate goes through their own tests, with their own doctors, focused only on their safety. Nothing on this page asks anyone to donate. Donation is the donor's decision alone, and buying or selling an organ is illegal in India.
If the answer is no, or not yet
A no is not the end of treatment. CION continues to plan cancer care at its centres, including immunotherapy, targeted therapy and supportive care, and coordinates TACE or ablation through partner hospitals. A not yet often means a specific problem to fix first, such as an infection, dental work, or building strength.
Being straight with you
What this page cannot tell you
It cannot tell you which tests your transplant centre will ask for, or in what order. Each centre has its own protocol, and it changes as evidence changes. It cannot tell you whether you will be accepted, which depends on how all the results fit together.
It cannot tell you about cost or waiting
Assessment tests are billed separately from the operation and vary by centre. Scheme and insurance cover for transplant, including Aarogyasri and Jeevandan rules in Telangana, change over time and must be checked with the transplant centre at the time. CION cannot influence waiting-list priority or organ allocation.
Who can answer
The transplant coordinator at the centre can give you the list and a written estimate. CION's surgical oncology team can help you prepare your records, explain results, and keep cancer treatment going so you stay within the limits while the assessment runs.
Keep one folder with every report and scan disc. It saves repeat tests and days of travel.Questions we are asked
Common questions about the transplant assessment
How long does the transplant assessment take?
Many centres complete the core tests within a few days to a couple of weeks, sometimes with a short admission. It can take longer if a test raises a new question, such as a heart problem that needs a further scan. Ask the transplant coordinator for a timetable before you travel.
Do I need a new scan if I had one recently?
Often yes. Liver cancer can change within weeks, and the transplant team needs a recent, good-quality triple-phase CT or MRI they can trust. Bring older scans on disc too, because comparing them shows how the cancer has behaved over time.
Why do they test my heart if the problem is my liver?
The operation puts heavy strain on the heart, and heart disease is common in people with diabetes and fatty liver. A heart problem found early can often be treated before surgery. One found during surgery is far more dangerous.
Will they ask about alcohol?
Yes, everyone is asked, whatever the cause of their liver disease. Be honest. The question is about keeping the new liver safe, not about blame. Hidden drinking discovered later causes far more trouble than an honest answer now. See alcohol requirements before transplant.
Does hepatitis B stop me getting a transplant?
No. Hepatitis B is a common reason for liver cancer in India, and people with it receive transplants. It is controlled with antiviral medicines before and after the operation, guided by the hepatologist. The infection stays controlled rather than gone, so the medicines usually continue long term.
Can the tests be done near home?
Some blood tests sometimes can, if the transplant centre agrees. Most centres want the scans, heart tests and specialist meetings done with their own team so the results are read the same way. Ask before you book anything locally.
Does my cancer treatment stop during the assessment?
It should not stop without a reason. Many people need TACE or ablation to keep the cancer inside the limits while they are assessed and while they wait. Your oncologist and the transplant team agree the timing together.
How can CION help with the assessment?
CION's team can review your case at the tumour board, organise your records, coordinate the referral to a licensed transplant centre, and keep your cancer treatment going. The tests themselves and the decision to list you belong to the transplant centre.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- NIDDK — Liver Transplant - NIDDK
- MedlinePlus — Liver Transplantation
- NHS Blood and Transplant — Liver - Organ transplantation - NHS Blood and Transplant
- EASL — EASL Clinical Practice Guidelines: management of hepatocellular carcinoma
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Liver Transplant for Liver Cancer: Who It Is ForStart here if you are still decidingPsychological and Social Assessment Before TransplantThe part of the assessment families worry about mostHow to Register on the Transplant Waiting ListWhat happens once you are acceptedWho Can Be a Living Liver Donor?How the donor's own assessment works
Talk to us
Have you been referred for a transplant assessment?
We can review your scans and reports, help you prepare your records, and keep your cancer treatment on track while the transplant centre assesses you. One helpline serves every CION centre.