- Child-Turcotte-Pugh class B or C
- MELD score ≥14 to 15
- No longer a transplant candidate or patient refusal of transplant
- Complications, such as ascites, bleeding varices, or hepatic encephalopathy, that are difficult to manage or are treatment refractory
- Severe muscle wasting and cachexia
- Development of hepatorenal syndrome or renal failure
- Impaired function in daily activities or dependence on others
| - Familial factors including:
- Inadequate caregiver support or family discord so that the patient has unmet needs
- History of intensely dependent relationship(s)
- Parental concerns regarding care of dependents
- Unresolved grief or multiple prior losses
- Disagreements about goals of care
- Spiritual/existential crisis
- Need for coordination of care at multiple sites
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