There is a six-month waitlist for liver transplant. What are our options?

Hello doctor,

My brother, 46, has ALD cirrhosis. He was admitted to a hospital. Day-6 now. And is undergoing withdrawal and other treatment. MELD score is 22-24; ammonia 40 (down from 70). Low platelets, lot of bruises from falling pre-admittance. Signs of advanced hepatic encephalopathy. Treatment includes Rocephin, Librium, Lasix, Lactulose, Keppra, Magnesium and multivitamins, Presnison, Rifaximin, and Spironolactone.

Prognosis is very unclear as assessments are day by day. Due to the UNOS policy, any transplant (including live donor, which I would do) will not happen for six months due to a waitlist. It is almost a death sentence and unfair. Especially in the context of a live family donor.

What else can we do to immediately treat his degrading condition from a medical perspective? He has zero energy, cannot feed himself, barely can talk. Just last week, he was walking around and fairly alright (according to wife).

Can we introduce alternative medicine?

Hello doctor,

Thank you very much. A few more questions:

1. Any specific and key questions that I should ask my gastroenterologist?
2. Our biggest concern is getting him out of this very very lethargic state which has onset him so he can have a clear mind to self-motivate - hard to believe it is just the meds and hard to believe it is the liver as figures are same or slightly better.
3. We think he may also have hepatic encephalopathy. So, anything else we can do apart from current meds?
4. When would assisted liver machine (I researched MARS) be advisable? Any more details appreciated.

Thank you doctor,

Are you able to tell me anything we can do about his quick onset of lack of good dexterity with arms and hands? Is this due to the liver and body simply being sober for seven days now after 10 years of drinking? Also, any insight on the MARS dialysis appreciated apart from what I can find from the internet.

Hello,

Thanks this is helpful. If his liver gets progressively worse and they do not transplant till six months of sobriety here, if his life depends on it, could he get a transplant in your country? Is this common?