**6. Indications of liver transplant and prioritization criteria on the waiting list**

When should a liver transplant be considered? There are medical and ethical concerns about the appropriate use of scarce resources, and the degree of priority given to patients with ALD has always been a controversial issue (Kotlyar, 2008). In recent years, approximately 1200 liver transplants have been performed in Spain yearly. This means that on average three livers are received every day.

Referrals to transplant centres should be made considering there is enough time to evaluate the candidate. Pretransplant evaluation and follow-up is a combined effort of clinicians, psychiatrists and substance abuse specialists. Assessment from medical, surgical and psychosocial points of view takes time and sometimes it can be like a race against time (Gutteling, 2007). Later referrals leave little scope to explore further medical management options or to allow time to work with the substance misuse or psychiatric team. Abstinence before transplantation evaluation and listing is important to select patients who would benefit the most from transplantation, as some would get better in this period (Drent, 2009). There should be reservations in listing patients with a lack of social support, active smokers, having psychotic or personality disorders, or a pattern of nonadherence.
