Liver Transplantation (CPB 0596, reviewed 2026-09-08)
Aetna considers orthotopic liver transplantation medically necessary for members with end-stage liver disease from the listed conditions who meet the criteria below. Adolescents 12 years of age or older and adults qualify with a MELD score greater than 10, approval by the UNOS Regional Review Board, or when they meet the transplant institution's selection criteria, and children under 12 qualify when they meet the transplanting institution's selection criteria. Liver transplantation is not medically necessary for absolute contraindications including active sepsis outside the biliary tract, inability to adhere to the transplant regimen (including homelessness, active substance abuse, and unstable psychiatric disease or psychosocial problem), presence of other effective treatments or surgical options, and significant organ system failure other than kidney, liver or small bowel.