• How Status on the Waiting List is Determined - Transplantation

    After careful research, in February 2002, the United Network for Organ Sharing (UNOS) implemented a new, nationwide system for prioritizing patients for liver transplantation. This system, the Model for End Stage Liver Disease (MELD), is based on a statistical formula that is very accurate for predicting which individuals are most likely to die the soonest from liver disease.

    MELD uses a mathematical formula based on three routine blood tests to generate a score for each patient. The score can range from 6 to 40. A patient's need for transplant is greater when the score is higher. The blood tests that are used to determine each individual's score are:

    • Bilirubin, which measures how effectively the liver excretes bile. When the bilirubin is high in the blood, a patient may appear yellow, or jaundiced.
    • INR (prothrombin time), which measures the liver's ability to make clotting factors
    • Creatinine, which measures kidney function. Impaired kidney function is often associated with severe liver disease.

    Research has shown that the MELD formula can accurately predict the short-term (three months or less) risk of death for most patients with liver disease, without receiving a transplant. The accuracy of the formula did not improve when other factors such as the cause of liver disease or symptoms (e.g., ascites, encephalopathy, variceal bleeding) were added.

    Each patient's MELD score must be updated according to a schedule determined by UNOS. A patient's score may go up or down over time, depending on the status of his or her liver disease. Due to the patient's changing condition, his or her MELD score may need to be reassessed weekly, monthly, every three months or annually. The higher the score, the more frequently it will need to be reassessed. MELD scores automatically revert back to the previous lower score if the score is not updated in UNOS within the specified time period.

    Time on the waiting list is not a factor in getting a liver transplant. The only factor that decides who receives an organ is the severity of a patient's illness, as reflected in the MELD score.

    Please visit the following Web sites for additional information on the liver transplant waiting list:

    US Department of Health and Human Services, Organ Procurement and Transplantation Network. 

    United Network for Organ Sharing (UNOS)

    American Liver Foundation


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