Liver transplantation has emerged as a highly efficient treatment for a variety of acute and chronic liver diseases. However, organ shortage is becoming an increasing problem globally, limiting the applicability of liver transplantation. In addition, potential recipients are becoming sicker, thereby increasing the risk of losing the graft during transplantation or in the initial postoperative period after liver transplantation (three months). This trend is challenging the model for end-stage liver disease allocation system, where the sickest candidates are prioritised and no delisting criteria are given. The weighting of the deontological demand for "equity", trying to save every patient, regardless of the overall utility; and "efficiency", rooted in utilitarianism, trying to save as many patients as possible and increase the overall quality of life of patients facing the same problem, has to be reconsidered. In this article we are aiming to overcome the widespread concept of futility in liver transplantation, providing a definition of potentially inappropriate liver transplantation and giving guidance on situations where it is best not to proceed with liver transplantation, to decrease the mortality rate in the first three months after transplantation. We propose "absolute" and "relative" conditions, where early post-transplant mortality is highly probable, which are not usually captured in risk scores predicting post-transplant survival. Withholding liver transplantation for listed patients in cases where liver transplant is not deemed clearly futile, but is potentially inappropriate, is a far-reaching decision. Until now, this decision had to be discussed extensively on an individual basis, applying explicit communication and conflict resolution processes, since the model for end-stage liver disease score and most international allocation systems do not include explicit delisting criteria to support a fair delisting process. More work is needed to better identify cases where transplantation is potentially inappropriate and to integrate and discuss these delisting criteria in allocation systems, following a societal debate on what we owe to all liver transplant candidates.

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“病人优先”政策时代可能不合适的肝移植——寻找上限

肝移植已成为多种急慢性肝病的高效治疗方法。然而，器官短缺正在成为全球日益严重的问题，限制了肝移植的适用性。此外，潜在的受者病情加重，从而增加了移植过程中或肝移植术后初期（三个月）丢失移植物的风险。这一趋势正在挑战终末期肝病分配系统的模型，其中最严重的候选人被优先考虑并且没有给出除名标准。对“公平”的道义要求的权重，无论整体效用如何，都试图挽救每一位患者；和“效率”，植根于功利主义，试图挽救尽可能多的患者并提高面临相同问题的患者的整体生活质量，必须重新考虑。在本文中，我们旨在克服肝移植中普遍存在的无效概念，提供潜在不适当肝移植的定义，并指导最好不要进行肝移植的情况，以降低前三者的死亡率。移植后几个月。我们提出了“绝对”和“相对”条件，其中移植后早期死亡的可能性很大，而预测移植后存活率的风险评分通常不会包含这些条件。在肝移植不被认为明显无效但可能不合适的情况下，对所列患者不进行肝移植，是一个意义深远的决定。到目前为止，这一决定必须在个人基础上进行广泛讨论，应用明确的沟通和冲突解决程序，因为终末期肝病评分模型和大多数国际分配系统不包括明确的除名标准以支持公平的除名程序. 需要做更多的工作来更好地识别可能不适合移植的病例，并在就我们应为所有肝移植候选者提供什么的社会辩论之后，在分配系统中整合和讨论这些除名标准。因为终末期肝病评分模型和大多数国际分配系统不包括明确的除名标准以支持公平的除名程序。需要做更多的工作来更好地识别可能不适合移植的病例，并在就我们应为所有肝移植候选者提供什么的社会辩论之后，在分配系统中整合和讨论这些除名标准。因为终末期肝病评分模型和大多数国际分配系统不包括明确的除名标准以支持公平的除名程序。需要做更多的工作来更好地识别可能不适合移植的病例，并在就我们应为所有肝移植候选者提供什么的社会辩论之后，在分配系统中整合和讨论这些除名标准。