Death after psychiatric contraindications to urgent liver transplant for paracetamol overdose

Table 1 King’s College criteria for selection of acute hepatic failure patients suitable for liver transplantation[6]

Classifications	Characteristics
Paracetamol-induced acute hepatic failure	Arterial blood pH < 7.30 (irrespective of grade of encephalopathy)
	Or all of the following	Prothrombin time > 100 seconds (INR > 6.5)
		Serum creatinine > 300 μmol/L
		Grade III or IV hepatic encephalopathy
Non-paracetamol induced acute hepatic failure	Prothrombin time > 100 seconds (INR > 6.5) (irrespective of grade of encephalopathy)
	Or any 3 of the following (irrespective of grade of encephalopathy)	Age < 10 years or > 40 years
		Aetiology: Non-A/non-B hepatitis, drug-induced
		Duration of jaundice to encephalopathy > 7 days
		Prothrombin time > 50 (INR > 3.5)
		Serum bilirubin > 300 μmol/L

Citation: O'Grady JG, Alexander GJ, Hayllar KM, Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology 1989; 97: 439-445. Copyright © 2025 Elsevier Inc. *INR: International normalized ratio.

Table 2 Clichy criteria for selection of acute hepatic failure patients for liver transplantation[7]

Number	Criteria
1	Presence of hepatic encephalopathy
2	Factor V level of < 20% (if patient’s age < 30 years) or < 30% (if patient’s age ≥ 30 years)

Citation: Bismuth H, Samuel D, Castaing D, Adam R, Saliba F, Johann M, Azoulay D, Ducot B, Chiche L. Orthotopic liver transplantation in fulminant and subfulminant hepatitis. The Paul Brousse experience. Ann Surg 1995; 222: 109-119 2025. Copyright © 2025 Wolters Kluwer Health, Inc. and/or its subsidiaries.

Table 3 Absolute and relative psychiatric contraindications to urgent liver transplant in the Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh[14]

Absolute contraindications	Relative contraindications
5 or more episodes of deliberate self-harm, unless previous events occurred many years ago	2-4 Lifetime episodes of self-harm
Current substance dependence of active misuse in a severe, chaotic fashion	Current/recent substance misuse
Chronic, severe, poor-prognosis mental disorders, especially if refractory to treatment or where leading to patient incapacity to express wishes or understand circumstances	Other significant or serious pervasive mental disorder
Repeated non-compliance with medical or psychiatric care	-
Patient refusal of transplant with capacity

Citation: Potts SG. Transplant psychiatry. J R Coll Physicians Edinb 2009; 39: 331-336. Copyright © 2025 Royal College of Physicians of Edinburgh. Copyright is held by the Scottish Liver Transplant Unit who have given permission for publication.