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Originally published January 15, 2026
Last updated September 14, 2026
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The number of liver transplants performed in the United States is higher than it’s ever been. For patients in need, including those with end-stage liver disease, acute liver failure or liver cancer, it’s life-saving news, says a transplant surgeon with the USC Transplant Institute, part of Keck Medicine of USC. (The USC Transplant Institute also provides advanced heart, liver and lung transplant care and complex hepatobiliary care to patients living in Southern Nevada at its state-of-the-art facility Keck Medicine of USC – Las Vegas.)
Over the past decade, liver transplants in the U.S. have steadily increased, reports the United Network for Organ Sharing (UNOS). In 2023, a record-breaking 10,660 liver transplants happened in the U.S. — the highest number ever recorded in a single year, exceeding 10,000 for the first time ever. That number has only continued to increase. In 2024, liver transplants rose to 11,458, and in 2025, 12,344 liver transplants were performed.
Part of this increase is due to a rise in organ supply thanks to the evolution and accessibility of more sophisticated organ perfusion devices, which improve donor organ viability. This advancement has been quite impactful, as has the country’s opioid epidemic, which continues to lead to deaths from anoxic brain injuries.
Other advancements in the field will also sustain what hopefully will be a long-term increase in liver transplantation.
Machine perfusion has increased the supply of viable donor organs, preserving organs for a longer period of time until they can be transplanted. This technique is only improving, with more device companies working to advance the technology.
Machine perfusion has proven to be a massive, innovative leap in comparison to the traditional method of simply “putting organs on ice,” or static cold storage, whose preservation window is smaller and often risks ischemic damage to the organ. Instead, machine perfusion creates a body-like environment for the organ, using a machine to keep blood or perfusate — fluid that provides nutrients, oxygen and more — pumping through the organ as well as controlling the organ’s temperature and other parameters. Altogether, machine profusion allows transplant teams to monitor an organ in real-time to determine how viable it is for transplant.
After the liver is removed from a donor, it can stay on the machine sometimes for well over a day if needed. This means surgeons are able to use a lot of livers that they weren’t able to use before. That’s a big change that’s happened in the last five years, our expert says.
As opposed to ex vivo normothermic machine perfusion, normothermic regional perfusion (NRP) is especially promising and is much more cost-effective, with research so far showing potential improvement in graft survival with NRP. With NRP, donor organs are supported by ECMO in the operating room and can then be procured in a manner yielding much better results than historically achieved. It has been mandatory in several European countries since 2018 and is finding major believers in the U.S. as well, our expert says.
Advanced, high-volume transplant programs like the USC Transplant Institute are the likeliest to have access to this state-of-the-art technology. For example, the organ procurement organization One Legacy, which works with the USC Transplant Institute and other Los Angeles programs, has ramped up its efforts to deliver these organs on machine perfusion devices that will allow physicians to get people transplanted more quickly. In addition, device companies themselves are more likely to work with major transplant programs to run clinical trials on promising new machines.
Methods of screening patients for transplant candidacy, especially in the context of alcohol-associated liver disease, are also evolving. The USC Transplant Institute, for instance, has taken a lead on improving the prescreening process to make it more standardized and effective.
By helping transplant teams more accurately determine whether or not a patient’s alcohol use would likely relapse after transplant, better screening methods will ultimately result in more transplants that are successful.
The ability and desire to more aggressively treat alcohol-associated liver disease, both in the acute and chronic setting, has evolved, our expert says. Now, physicians have protocols set up to try to select patients who they think are not only going to have good outcomes from transplant but also who will be able to take care of their liver by controlling their index disease.
These efforts are also increasingly important as cases of alcohol-related liver disease have risen sharply in the past two decades.
Advanced, high-volume transplant programs like the USC Transplant Institute are continually finding ways to get patients transferred for treatment more quickly.
A good transfer center team can evaluate the patient’s needs, rapidly review social and family dynamics and deftly analyze financial and insurance particulars in order to immediately make a decision on whether to enact the transfer. At Keck Hospital of USC, where transplants are performed, a comprehensive transplant team is on call 24/7, 365 days a year.
To make the best decisions for a patient as efficiently as possible, the USC Transplant Institute’s transplant surgeons, hepatologists and ICU providers are also in constant communication.
Our expert continues: “Referring patients to us early always make a difference. We always stress that if you’re even thinking about contacting us, even if your patient hasn’t quite yet reached the transplant point, go ahead and do it. We’re always happy to take the call.”
Xenotransplantation is still in the experimental phase. Once it is widely available, however, the difference it makes could be tremendous.
As of now, the expert says, “It’s good to see that the field is advancing. It’s not necessarily ready for primetime yet, but certain transplant centers and biotech companies in the country are leading the way to get to the point where we can use more of these organs. It has already started in kidney transplant to a certain standpoint. This is important, because we have thousands of people still waiting on transplant lists.”
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