From queues to questions: Reflections on EASL’s Love Your Liver campaign in Amsterdam

This May, the European Association for the Study of the Liver (EASL) brought the EASL Congress 2025 to Amsterdam, where 7,725 delegates gathered from around the globe. As Europe’s leading event in hepatology, the Congress provides a platform for clinicians, healthcare professionals, researchers, scientists, and patient advocates to showcase cutting-edge clinical and basic science, foster collaborations and be at the forefront of scientific and clinical advancements in liver health. This year, however, another dimension was added. Upon arrival, the delegates were greeted by a highly unusual sight. Hundreds of Dutch citizens – many with families, friends and folding chairs in tow – waited patiently in long queues, some for as long as seven hours, to take part in what turned out to be an unprecedented public awareness campaign. EASL’s now-annual flagship initiative, Love Your Liver, marked its fourth edition with record-breaking success. Over the course of the five Congress days, 20 volunteers, operating six Fibroscan™ devices, tested over 840 members of the public. The disease awareness campaign garnered broad attention from local and national media, with coverage across major newspapers, morning radio, and national television. Demand for the liver testing so exceeded EASL’s expectations that testing capacity needed to be doubled on the second day. Overnight, this apparent demonstration of public interest in the liver became the talk of the Congress and beyond.

In this editorial, we reflect on the current events, outline the transformation of Love Your Liver from a small side event to an impactful project, and explore the opportunities as well as complexities of delivering public awareness in tandem with an international congress.

In 2021, the EASL-Lancet Commission published a landmark report detailing the status of liver disease and care in Europe in the 21^st century.¹ “A fundamental shift”, former EASL Secretary General Tom Karlsen and colleagues wrote, “must occur, in which health promotion, prevention, proactive case finding, early identification of progressive liver fibrosis, and early treatment of liver disease replace the current emphasis on the management of end-stage liver disease complications”. The radical shift in liver care called on by the Commission was incorporated into EASL’s Policy, Public Health, and Advocacy portfolio and began with the launch of EASL’s first set of community engagement activities, one of which involved a partnership with the British Liver Trust. The latter had pioneered a novel concept of holding roadshows across prominent public places in the UK, enabling the people to easily access information about liver health and providing free Fibroscan™ testing. Inspired by this concept, EASL went on to design Love Your Liver, featuring two core elements: 1) in the months preceding the Congress, national hepatologists deliver well-structured, interactive lessons in school classrooms to educate children on the liver’s function and the importance of a healthy lifestyle and 2) local volunteers offer education and free liver tests to members of the public, venue staff, and Congress delegates. Love Your Liver was launched during the EASL Congress 2022 in London and has been featured at every subsequent Congress since.

What started out as a small side event has evolved over four years into a mature impact project with tangible outcomes. Cumulatively, EASL has performed liver stiffness measurements on 2,300 participants, educated more than 670 schoolchildren, engaged over 50 local volunteers, collaborated with 40 local medical and public organizations and received recognition from over 40 media outlets. After every Congress, Love Your Liver has set off a ripple effect. For example, following EASL Congress 2023, the Vienna Board of Education integrated the lesson plan of the few visited schools into the school curriculum of the entire district, while, in response to ongoing demands, local hepatologists continued classroom visits throughout the country after the EASL Congress 2024 in Milan ended.

In alignment with the EASL Lancet Commission proclaiming liver health is public health, as well as with the United Nations Sustainable Development Goals (in particular, Goal 3 (Good health and well-being) and 4 (Quality education)),² EASL’s Love Your Liver appears to have struck exactly the right chord. Yet, on the back of such success lie potential risks and complexities that require careful reflection.

It is tempting to misinterpret free liver testing of the general public as population screening. This is, however, far beyond what this programme intends to be. Population screening requires adherence to a set of key principles, originally established by Wilson and Jungner in 1968,³ which pertain to disease relevance, test accuracy, treatment availability and cost-effectiveness. Although 1) cirrhosis and steatotic liver disease represent significant health concerns; 2) there is a recognisable latent or early symptomatic stage (i.e. fibrosis and MASLD/MetALD), and 3) this can be detected with reasonable accuracy using low-risk, non-invasive tests (i.e. liver stiffness and fat measurement), it is important to highlight that our programme is not designed to fulfil the other necessary principles. The liver stiffness measurements in this project are not formal diagnostic tests and are not conducted under ideal, standardized conditions. The next logical step, which, according to Baveno VII,⁴ would consist of confirmatory diagnostic testing (especially for those with LSM >10 kPa), would require a clinical context of the participant, an agreed policy on acceptable validity parameters and population-based rule-in or rule-out criteria, and a care plan delineating who is responsible for the full diagnostic assessment and when – all of which are undefined in Love Your Liver. Neither is there a standard procedure in place, outlining who would be responsible for treating those with confirmed disease, and whether or not the participants would have guaranteed access to an effective and reimbursable therapy. An effective screening program is thus not just a single test but rather a complete pathway that ends when treatment and follow-up are secured and the outcomes are reported and monitored. Tempting as it may be, for all these reasons, Love Your Liver should not be labelled as a population-screening programme.

This initiative could also easily be mistaken for research. After all, we are performing liver tests and thus generating quantitative data. Admittedly, this data could be of much interest to the scientific community. However, Love Your Liver has not undergone the rigorous process required for research project development including ethical approval. Indeed, participants sign a consent form confirming their voluntary participation, however this does not amount to an IRB-approved informed consent. As a result, the generated data cannot be used without risking the breach of ethical standards and clouding the current project’s main goals of delivering health awareness and societal impact. One may, however, reconsider doing this in the future.

To avoid such interpretive challenges, it is critically important that the goals and limitations of participation are communicated clearly and consistently across all educational and promotional materials. Love Your Liver aims to raise public awareness on the risks associated with an unhealthy lifestyle and inspire positive behavioural changes, ultimately working towards the prevention of liver disease. Liver elastography is only one of several tools supporting this goal. The local volunteers handling the devices are medical and PhD students, nurses and other community members, instructed on delivering educational information, not a diagnosis. Participants receive flyers that outline the basics of chronic liver disease and offer tips for maintaining liver health and are invited to reflect on their own lifestyle behaviours and metabolic health. Eventually they leave with practical health information, personal reflections and their own elastography results.

Yet, the large public turnout we saw this year raises an interesting question: was it truly the educational content that brought people in and kept them waiting patiently for hours – or was there a deeper motivation? Did they come to find out if they had liver disease? Did they seek reassurance? Could this reflect a broader readiness among the population for liver disease screening? Or was it a matter of the easy accessibility and free testing, teaching us that reducing barriers to healthcare can make a difference? We may never know for sure, as participant expectation and satisfaction were not systematically recorded. Be that as it may, it was after all these long lines that ultimately created a perfect storm and enabled Love Your Liver to generate its desired impact. Indeed, that was what attracted the attention of the media, sparked the public interest in liver health and prevention, captured the eye of policymakers, and brought liver disease into the spotlight on social media channels. And although not intended, those in the hepatology community who are working hard to push for earlier detection and prevention of liver disease may have seen all of this as a hopeful sign.

Liver disease is complex, can affect anyone and is often preventable. Hepatology societies such as EASL can be powerful public health actors in the battle against liver disease. With our collective expertise and credibility, we are uniquely positioned to engage communities, raise awareness, and make prevention more visible and accessible. By critically reflecting on our own recent experience, we gained valuable insights. There is clearly a public interest in liver health that we should cultivate and build upon in the future. And thoughtful framing and communication of the purpose to the public is essential for building community trust, guiding the public narrative and managing participant expectations. By embracing a shared responsibility, we strongly believe that EASL and its community can lead the way in preventing liver disease and empowering people to make healthier lifestyle choices.

Financial support

The authors did not receive any financial sponsoring for this manuscript. The EASL Congress 2025 Love Your Liver initiative was financially sponsored by Boehringer Ingelheim, EchoSens, MSD and NovoNordisk. In addition, Echosens provided the Fibroscan™ devices for free. None of the sponsors were involved in the content creation or execution of Love Your Liver, nor were they involved in the conceptualization, drafting or revision of this manuscript.

Authors’ contributions

SDM and MB: conceptualization, manuscript preparation, revision. SZS, BH, DLS: conceptualization, revision.

Conflict of interest

All authors are part of the EASL Governing Board (SDM, SZS, DLS) or EASL office (MB, BH). DLS serves as EASL Secretary General, SDM as Scientific Committee chair and SZS as Public Health counsellor. BH is CEO of EASL and MB is PPHA programme manager. The authors declare no other conflicts in relation to this report.

Please refer to the accompanying ICMJE disclosure forms for further details.

Supplementary data

The following are the Supplementary data to this article: