 Hi, I am Dr. Ravichan Siddhachari. I am a consultant hepatobiliary and liver transplant surgeon for Manipal Hospital Group, Bangalore. Liver transplantation is necessary when the liver is irreversibly damaged. When I say irreversibly damaged, that means the liver is not able to perform its normal functions. So, this is called as decompensation. When the decompensation occurs, the liver has damaged to such an extent that it cannot repair and it cannot get restored to its normal functions. The symptoms of decompensation are the fluid buildup in the body or the belly. There may be a low discoloration of the skin or the sclera or the eye. There will be vomiting of the blood. The person can have confusion and can have some fainting. So, when these symptoms develop, the patient almost definitely needs liver transplantation. The people think that there is some percentage of liver is affected or one part of the liver is affected. So, rest of the liver is not affected. So, it may not be necessary. It is not that the liver, when it gets damaged, the whole liver gets damaged. So, there is a scoring system we have accepted internationally which tells you about how much liver is damaged. So, this is called Melt score. So, this score is based on the laboratory values. So, according to this scoring system, a patient with about 15 or more will need liver transplantation. Somebody with 25 or more is very sick and definitely need liver transplantation and carries bigger risk. There is also one more condition called acute liver failure where person has a normal liver, develops a disease in the liver and within few days or hours his liver is deteriorating so fast that he will need liver transplantation within a week. Otherwise, he is going to die. This is called as acute liver failure.