United Network for Organ Sharing (UNOS)’s Post

Transcript

The model for end stage liver disease, or MELD, is used to assess a liver transplant candidates medical urgency. It is used for liver transplant candidates age 12 and older. The score uses medical facts and current lab test results for the individual patient. These factors have been found scientifically to affect the person's likelihood of surviving 3 months without a transplant. The Meld score ranges from a minimum of 6, meaning the least medically urgent, to 40, meaning the most medically urgent. To calculate the MELD, medical professionals enter into a computer a few facts about the patient. These include date of birth. Whether the person is male or female and albumin lab test result, which is a blood protein produced by the liver. A bilirubin lab result, which is a substance within bile that is made by the breakdown of red blood cells. A lab result measuring serum sodium. Higher sodium levels can be a sign that the liver is not functioning well and I and R lab result, which measures how well the blood is able to clot a serum creatinine lab result which measures kidney function. A computer then calculates the patients meld. And the MELD score is recorded with the OPM, the National Organ Procurement and Transplantation Network. Because the medical condition of liver patients may change overtime, they may need updated lab tests if they are not transplanted quickly. Candidates with the lowest MELD scores, those between 6:00 and 10:00, need new tests reported once each year. For higher scores. The more urgent patients, the tests are repeated more frequently. Adults with a MELD score of 25 or higher must be retested once a week. Children under 18 with a MELD of 25 or higher must be retested every two weeks. The MELD formula is used for most, but not all, liver candidates age 12 and older. A small number of people have such an immediate need for a transplant that they are in one of two special statuses status 1A or 1B. People in these statuses have one of a few rare and severe medical conditions that require them to be transplanted within days or a few weeks in order to survive. Status 1A candidates can be adults or children. Status 1B candidates are children only. There are very few candidates and either status at any time. In addition, some people may qualify for a MELD exception score. This is because they have a medical condition, such as liver cancer, that progresses at a different rate than their MELD will measure. This is an assigned score, usually higher than their calculated MELD, that better reflects their need for a transplant. If a candidate has an exception score, that score will be used to prioritize them instead of their calculated meld. The patients Transplant program must apply for a MELD exception and provide data and medical information to support having an exception. In addition, any person listed for a liver transplant prior to their 12th birthday is prioritized according to a different formula. This is called the pediatric end stage liver disease formula, or PELLED. The Pelled calculation uses some of the same medical data and information as Mel does, but it includes some other medical facts that are more specific to how liver disease effects young children. Several different factors are used to set the order of candidates to be offered any donated liver. But the medical urgency is one of the most significant considerations. Any Status 1A or Status 1B liver transplant candidate who is medically compatible and listed within 500 nautical miles of the donor hospital would be considered first for liver offers. Again, there are very few candidates in either status. After that, liver offers are made by a combination of the medical urgency score and the distance from the donor hospital to the transplant hospital where each patient is listed. In general, the higher a patients MELD or PELD score is and the closer that patients hospital is to the donor hospital, the more priority they will have for the organ. The sequence starts with patients who have a meld or peld score of 37 or higher. It then moves through other groups of meld and peld scores in descending order. If two or more liver candidates have the same MELD or peld score, waiting time is a tie breaker. The person who has waited longer gets priority ahead of others who have not waited as long. Your liver transplant team will have the most detailed information about your current medical condition and how it may affect your MELD score. If you were listed for a liver transplant, the OPTN will have the information to calculate your MELD. An online sample calculator is available on the OPTN website for you to enter your information and estimate what your MELD score may be. For more information, call the OPTN Patient Services line at 1-888-894-6361 or click here to send an e-mail.