Liver Transplantation

Aetna covers orthotopic liver transplantation (cadaveric, reduced‑size, living‑related and split) for children who meet the transplant center’s selection criteria, adolescents ≥12 and adults with MELD >10 or UNOS Regional Review Board approval for end‑stage liver disease from specified cholestatic and hepatocellular indications, and for primary hepatocellular carcinoma confined to the liver when UNOS tumor size/number criteria are met and there is no extrahepatic or macrovascular disease; transplants are not covered for listed absolute contraindications and numerous listed therapies/procedures (e.g., many machine‑perfusion techniques, hepatocyte transplantation, certain immunosuppressants and biomarkers) are considered experimental/investigational. Key requirements: MELD ≤10 (without UNOS approval) and pediatric/adolescent requests without institutional criteria are subject to medical‑necessity review, and retransplantation is covered only if the initial transplant was for a covered indication.