Introduction Over the past 20 years, the European Transplant Registry (2010) reports nearly 75,000 transplants and the United Network of Organ Sharing (UNOS 2007) in the United States nearly 100,000. No registry of worldwide liver transplants (LTs) exists. More people wait, and many die waiting, because transplantation is both costly and uses scarce resources. Liver failure is typically insidious in onset. Most people enter transplant surgery following serious disruptions in the way they are able to function. This disruption is characterised in a study of 15 occupational therapists in the north-east of England and Scottish borders who treat people with chronic liver disease as due to encephalopathy, fatigue, confusion, weakness and social isolation (Elliott et al 2010). Liver transplantation is a complicated surgery followed by long recovery, lifelong drug therapy and habit change to prevent rejection. Not surprisingly, LT patients may experience significant disruption in role participation both while they have chronic liver disease and after transplant surgery (Forsberg et al 2000, 2002).