The patient has:

  • Prothrombin time (PT) more than 5 seconds over control, or International Normalized Ratio (INR) >1.5
  • Serum albumin <2.5 gm/dl and

And one or more of the following conditions:

  • Ascities, refractory to treatment or patient non-compliant
  • Spontaneous bacterial peritonitis
  • Hepatorenal syndrome; elevated creatinine and BUN; oliguria {< 400 ml/day}; urine sodium concentration < 10 mEq/l; cirrhosis and ascites
  • Hepatic encephalopathy, refractory to treatment or patient non-compliant
  • Recurrent variceal bleeding, despite intensive therapy

Supporting documentation:

  • Progressive malnutrition
  • Muscle wasting with reduced strength and endurance
  • Continued active alcoholism (>80 gm ethanol/day)
  • Hepatocellular carcinoma
  • HbsAg (Hepatitis B) positivity

A physician may determine that a patient has a life expectancy of six months or less even if the above findings are not present. Co-morbidities also support eligibility for hospice care.