Symptoms experienced by patients with end-stage liver disease (ESLD) may be well known to a physician, but determining hospice eligibility can be difficult, especially for patients eligible for transplant.

Patients will be considered to be in the terminal stage of liver disease, and typically eligible for hospice, if they meet the following criteria: 1 and 2 MUST be present; factors from 3 will lend supporting documentation.

1. The patient has end stage liver disease as evidenced by BOTH of the following:

  • Prothrombin time prolonged more than 5 seconds over control, or International Normalized Ratio (INR)>1.5
  • Serum albumin


2. The patient shows at least ONE of the following:

  • Ascites, refractory to treatment or patient non-compliant
  • Spontaneous bacterial peritonitis
  • Hepatorenal syndrome (elevated creatinine and BUN with oliguria (<400ml/day) and urine sodium concentration
  • Hepatic encephalopathy, refractory to treatment, or patient non-compliant
  • Recurrent variceal bleeding, despite intensive therapy

3. Documentation of the following factors will support eligibility for hospice care:

  • Progressive malnutrition
  • Muscle wasting with reduced strength and endurance
  • Continued active alcoholism (>80 gm ethanol/day)
  • Hepatocellular carcinoma
  • HBsAg (Hepatitis B) positivity
  • Hepatitis C refractory to interferon treatment

Patients awaiting liver transplant who otherwise fit the above criteria may be certified for the Medicare hospice benefit, but if a donor organ is procured, the patient must be discharged from hospice.

If a patient meets the medical criteria above, they are by definition eligible to receive hospice services. Some patients may not meet the criteria, but may still be eligible for hospice care due to comorbidities or rapid functional decline.

We rely on the experienced clinical judgement of physicians as a foundation for hospice eligibility. Medical directors at our local Compassus locations are available for consultations.