About MELD

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http://www.cpmc.org/advanced/liver/patients/topics/MELD.html

What is MELD? How will it be used?

The Model for End-Stage Liver Disease (MELD) is a numerical scale, ranging from 6 (less ill) to 40 (gravely ill), that will be used for adult liver transplant candidates. It gives each individual a ‘score' (number) based on how urgently he or she needs a liver transplant within the next three months. The number is calculated by a formula using three routine lab test results:• Bilirubin, which measures how effectively the liver excretes bile;• INR (prothrombin time), which measures the liver's ability to make blood clotting factors; and• Creatinine, which measures kidney function. (Impaired kidney function is often associated with severe liver disease.)The MELD score replaces the previous Status 2A, 2B and 3 categories. The Status 1 category (patients who have acute liver failure and a life expectancy of less than 7 days without a transplant) will remain in place as the highest priority for receiving an organ and will not be affected by the MELD system.A patient's score may go up or down over time depending on the status of his or her liver disease. Many patients will have their MELD score assessed a number of times while they are on the waiting list. This will help ensure that donated livers go to patients in greatest need at that moment. Additionally, special case exceptions are in place for patients with diagnoses such as hepatocellular carcinoma.

What led to the new system?

For the last few years, patients needing liver transplants have been grouped into four medical urgency categories. The categories were based on a scoring system that included some laboratory test results (such as bilirubin, INR and albumin) and some symptoms of liver disease (such as ascites and encephalopathy). One concern with using symptoms in scoring is that different doctors might interpret the severity of those symptoms in different ways. In addition, this scoring system could not easily identify which patients had more severe liver disease and were in greater need of a transplant.Research showed that the MELD formula very accurately predicts most liver patients' short-term risk of death without a transplant. The MELD formulas are simple, objective and verifiable, and yield consistent results whenever the score is calculated.

How will waiting time be counted in the system?

Under the previous system, waiting time was often used to break ties among patients of the same medical status. Various studies, including one done by the Institute of Medicine, report that waiting time is a poor indicator of how urgently a patient needs a liver transplant. This is because some patients are listed for a transplant very early in their disease, while others are listed only when they become much sicker. Under the new plan, with a greater range of MELD scores, waiting time will not have to be used as often to break ties. Waiting time will only determine who comes first when there are two or more patients with the same blood type with the same MELD score. Patients with a higher MELD score will always be considered before those with lower scores, even if some patients with lower scores have waited longer.

What happens if I'm already on the waiting list when the system changes to MELD?

A transition plan will allow you to maintain the priority gained under the previous system. If you are an adult Status 2A patient, you will be given priority ahead of new adult patients listed under the MELD system for the first 30 days after MELD takes effect (February 28 - March 28, 2002). If you do not receive a transplant within 30 days, your MELD score will be calculated at that time, and you will receive 30 days of waiting time at that score.If you are a Status 2B or 3 patient, your MELD score is calculated at the time the new system takes effect.

Is this system likely to change?

As transplant professionals apply and learn from the MELD system, some changes will likely be required to better meet patients' needs. In fact, this system is designed to be flexible and allow improvements. In transplantation, as in all scientific fields, new studies are taking place all the time to learn how to save more lives and help people live longer and better