Further Development Of Liver Urgency Scale The new MELD system

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http://www.applesforhealth.com/OrganDonation/fdlus3.html Studies of systems that rank patients by priority, such as the MELD scoring system have suggested that a change to the MELD system will most likely reduce deaths on the liver waiting list. Instead of the current system that ‘lumps’ patients together in one of only 3 groups (Status 2A, 2B or 3), the MELD system will give you your own individual urgency status. By going to a more continuous scale, the system will more accurately indicate which patients are most in need. As you become in greater need of a transplant, your MELD score will increase, and you will move up in the ranking, thus receiving greater priority for organ offers. What will my MELD score be? Your individual MELD scores will be calculated by inserting your individual lab test results into a formula. As your lab results change, so will your MELD score. Your MELD score can go up and down as you wait for a transplant. As your MELD score increases, these lab tests will be done more frequently. The MELD score can range from 10 (less ill) to 40 (gravely ill). How will waiting time affect the MELD system? The MELD system puts emphasis on your need of a liver transplant in the next 3 months. Waiting time will be used as a tiebreaker if two patients with the same MELD score are offered an organ. Under the current system, waiting time is a principal factor in determining who is offered a donated liver. The Institute of Medicine has reported that waiting time is a poor indicator of how urgently a patient needs a liver transplant. What if I am already on the waiting list? You will be ‘grand fathered’ into the MELD system. You will be given credit for the time you have already been on the list. You will then continue to be ranked according to the severity of your illness, your MELD score. What about pediatric patients? Candidates under the age of 18 will be ranked according to the Pediatric End Stage Liver Disease (PELD) scoring system. This system is similar to the MELD, but recognizes the specific needs of children. Pediatric Status 1 will remain in place. Status 2B and 3 will be replaced with the PELD policy. (There is no Status 2A for pediatric patients.) When will the MELD system go into effect? The system and computer programming are still being refined. The new system is expected to take effect after final approval at the November 2001 OPTN/UNOS Board of Directors meeting. -- Information Provided By UNOS --