ENA liver transplant in Germany is considered when the liver can no longer do its work and other treatment has run out. The diseased liver is replaced with a whole liver from a deceased donor or with part of one from a living donor, such as a relative.
For families abroad, the operation is only part of the story: the assessment, the source of the organ and years of follow-up decide whether the plan is realistic.
When a Liver Transplant Is Considered
A transplant is considered when liver disease cannot be reversed, keeps progressing and threatens life, with no acceptable alternative. The most common reason is advanced cirrhosis (see liver cirrhosis treatment in Germany). Others include acute liver failure, some inherited and metabolic diseases, bile duct diseases and selected cancers confined to the liver (see liver cancer treatment).
Active alcohol use, an uncontrolled infection, severe heart or lung disease or a tumour that has spread beyond the liver can delay or rule out the operation. With alcohol-related cirrhosis, listing as a rule requires six months without any alcohol. The decision is made by the centre’s transplant board, not by one doctor.
Deceased and Living Donors: What Applies to Patients from Abroad
Deceased-donor livers in Germany are allocated by Eurotransplant, which also serves Austria, Belgium, Croatia, Hungary, Luxembourg, the Netherlands and Slovenia, under the rules laid down by the German Medical Association (Bundesärztekammer) in its guideline on liver transplantation. The waiting list is one nationwide list of patients accepted by transplant centres; the order depends mainly on urgency, calculated from blood tests (the ReMELD-Na score), and on the chances of success.
The guideline has no separate rules for residents of other countries and states that the chance of receiving an organ must not depend on place of residence, social status or money. Eurotransplant leaves non-residents’ access to the list to national rules but tells its centres not to encourage travel from outside its region for a deceased-donor transplant, so nobody can promise a place on the list. Listed patients must also be reachable around the clock and able to reach the centre quickly, so in practice they live nearby.
The second route is living donation: part of a healthy donor’s liver is transplanted, the remaining liver grows back almost to its original size, and the operation can be planned. The German Transplantation Act, which applies to patients from abroad too, allows this only for a first- or second-degree relative, a spouse or registered partner, a fiancé or fiancée, or someone evidently close to the donor through a special personal bond. Doctors and an independent psychologist assess the donor, who must be a healthy adult, and a living-donation commission checks that consent is voluntary and no organ is traded, a crime in Germany.
Assessment and the Operation
Before listing, the centre checks whether the body can withstand the operation: detailed blood tests, including for hidden infections, ultrasound and CT or MRI of the abdomen, heart and lung tests and a dental check, as teeth can harbour infection. A psychologist or psychiatrist and a social worker also see the patient, partly to ask about family support. This is done as an outpatient or in hospital.
The operation takes several hours under general anaesthesia, followed by intensive care and then the transplant ward; the length of stay depends on the condition before surgery. Immunosuppressants, which damp down the immune system, are needed for life to prevent rejection; as they also weaken defences against infection, doses are adjusted by regular blood tests and follow-up at the centre is lifelong.
What the Cost Estimate Covers
There is no single price: the hospital issues an individual cost estimate (Kostenvoranschlag) after reviewing the records. Check that it covers the assessment, operation, intensive care and ward stay, plus the donor’s work-up and surgery with living donation. University Hospital Tübingen, for example, asks for an extra payment if treatment proves more complex than expected and refunds any overpayment after the final invoice.
Often forgotten: after discharge the patient stays near the centre for a while, as early check-ups are needed two to three times a week. Budget also for medicines, repeat visits and travel and accommodation for the donor and a companion. Payment goes to the hospital, usually in advance: patients from abroad transfer the estimated amount before admission.
Frequently asked questions
How long is the wait for a donor liver?
Nobody can say in advance: the wait can last from a few months to several years. The order depends on urgency, blood group and the chances of success. A patient who travels far from the centre must tell it and cannot receive an organ meanwhile.
Can you pay to get a liver sooner?
No. Deceased-donor livers are allocated by urgency and the chances of success, and under the German Medical Association’s rules money must not affect a patient’s place. Organ trading is a criminal offence in Germany, including for anyone buying an organ from a living donor. The only payment is to the hospital, for the treatment itself.
Is living donation risky for the donor?
Yes, as with any major liver operation: wound healing problems, fever, bile leaks or bile duct inflammation and fluid around the lungs can occur. Most operations go without complications, and the remaining liver grows back and fully takes over its work. Donors are closely followed up, and the law allows donation only if the risk stays within that of the operation itself.
Transplant Centres and How AlenMed Arranges Treatment
Only approved transplant centres may carry out this operation. At University Hospital Leipzig, for example, Prof. Daniel Seehofer heads liver and bile duct surgery and abdominal organ transplantation, with living-donor transplants for adults and children. At University Hospital Tübingen, Prof. André Mihaljevic is medical director of the Department of General, Visceral and Transplant Surgery, to which the transplant centre with its liver programme belongs. At University Hospital Essen, the Surgical Clinic for Visceral and Transplant Medicine (Chirurgische Klinik für Viszeral- und Transplantationsmedizin; Prof. Ulf P. Neumann) and the Department of Gastroenterology, Hepatology and Transplant Medicine (Prof. Hartmut Schmidt) jointly care for liver transplant patients.
AlenMed collects reports, scans and liver function results, translates them and sends them to transplant centres that perform a liver transplant in Germany for a written opinion. It then arranges the assessment visit, an interpreter, the visa for medical treatment in Germany and long-stay accommodation; the company office is in Munich.
This material is for reference only and is not an offer. Whether a transplant is possible is decided by the transplant centre after an in-person assessment.
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