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Great Subject! It is my understanding the MELD scoring system is to determine HOW sick you are. Your already a member in the ESLD club, and your welcome in the room with other members. No questions there... but your "assigned" seating is determined by the MELD. For example, if there are only two people in Houston, that need a TP, (Pt. A and Pt. and Pt. A has been on the list waiting for six months......and still no liver, and Pt B has only been in for 3 days, Pt. B should get the next available Liver, (providing it's compatible), if his MELD is higher than that of Pt. A. In other words, livers aren't passed out on a first come, first served basis. They are given to the sickest person in the room. The one that may die the soonest. Is it fair? Yes and no..... is it right? I don't know..... Is there a better way to delegate the who gets

this liver question? I'm sure they would show interest if someone came up with a better plan. I don't know if this MELD system is morally or ethically correct, because there are many other determining factors. I think, my opinion only, when evaluating the MELD, there are other factors that come into play. Things such as, how is the Pt.s health in general? How has their attitude been since the beginning... Do they do exactly what they are told... is their support group strong enough? Has he shown to be responsible in taking prescribed meds as directed? I am honestly not sure how this decision (who gets the liver) is final. I DO know this... whenever you are dealing with humans, and not facts, there is a 'grey area' concerning the decision. This ultimately leads to personality differences, members of the support groups demeanor, the patients demeanor

and attitude, and other similar issues. Example.... Pt.A (25 MELD) is always on time for appts, has a positive, cheery disposition, causes everyone to feel good when he's around, a stellar personality, and has what appears to be a bright future ahead. Baby on the way, etc........ NOW..... Pt B,(26 MELD) is either late for appts. or rescheduled all together, curses, whines and moans, picks his nose, passes gas, looks and smells like an unfortunate homeless person, and spits tobacco on the floor.... while ogling nurses. But.... he has his family as a support team and has met the other requirements. I believe atleast one person on the Liver Approval Board may be just a little swayed in their "vote" as to who gets the liver. The one that cursed out Nurse (sounded good), and is

always rude to her? His MELD IS higher..... Who would you choose? Pt A is a 25 MELD and Pt. B is a 26 MELD. It is hard to say who Nurse will choose. The insensitive, computer like logical answer, without any deliberation, would be Pt B. No questions, because of the rules. But... here we the have Pt. A, and this is SOOOOooo close, how can deny him? His poor baby,etc....... This is the Human Factor. The 'correct' answer is Pt B.......... following the guidelines of MELD. The 'right ' answer is Pt A..in my foggy mind................ It's not easy sometimes to do what we have agreed to do, following rules, and not succumb to our own personal feelings. The saying" decide with your heart", should not come into play, but it does.......... we're Human..... Del __________________________________________________