Driving in hepatic encephalopathy.

Hepatic encephalopathy (HE) is a reversible neuropsychiatric complication of cirrhosis associated with cognitive and psychomotor impairment that may compromise driving safety. Deficits in attention, visuospatial ability, reaction time and executive function contribute to impaired on-road performance and increased motor vehicle collision rates. Despite this, there are no standardised Australian guidelines addressing driving in patients with HE, and international guidelines remain heterogenous. This article reviews the impact of overt (OHE) and covert HE on driving performance and outlines a pragmatic, risk-stratified framework. For patients with prior OHE, our approach is a time-limited driving restrictions based risk assessment, with conditional return to driving following sustained clinical stability and adherence to therapy. This framework aims to balance public safety with preservation of patient autonomy and quality of life.