UNOS Waiting List
After you have a formal evaluation, our multidisciplinary Liver Transplant Screening Committee decides if you are a candidate for liver transplantation and adds you to the waiting list. As soon as a liver is available, we contact you. We may contact you at any time of the day or night, so you should always be prepared for our phone call. We have 60 minutes to reach you before we make the liver available to the next person on the list.
We are part of the United Network for Organ Sharing (UNOS), the national organization in charge of administering and allocating organs from deceased donors. UNOS uses the following criteria to rank the priority of potential organ recipients for liver transplants:
- Urgency of condition: Within each blood type list, people are ranked by the urgency of their medical condition. This is indicated in general by their model for end-stage liver disease (MELD) score.
- Location: Available organs are allocated within their local region. The United States is divided into 11 regions, each with its own supply and demand. Lahey is part of UNOS region 1, which includes most of New England.
- Blood type: Within each region, the liver transplant waiting list is divided into four different lists separated by blood group: O, A, B and AB. The + or – after a blood type is not a factor in liver transplantation, so for example, an O+ person can donate to an O- recipient.
- Liver size: Your body size is another consideration in liver allocation. The donor’s liver has to have an adequate volume for the transplant to be a success. If you are a large person, a small liver won’t provide you with sufficient function.
UNOS forbids organ allocation based on any other factors, such as age, sex, race or socioeconomic status. It is also illegal to purchase a liver or any other organ.
About the MELD Score in Liver Transplantation
In 2002, UNOS implemented a nationwide system for prioritizing patients for liver transplantation. It is called the Model for End Stage Liver Disease, or MELD, and it is based on a very accurate statistical formula that predicts which people are most likely to die in the near future from their liver disease.
The MELD score is determined by using the results of three blood tests (bilirubin, INR and creatinine) to determine the severity of a person’s liver disease. The score ranges from 6 (normal liver function) to 40 (severe liver disease).
While on the waiting list, each person’s MELD score must be updated according to a schedule determined by UNOS. The score may go up or down over time, depending on the status of the patient’s liver disease. A MELD score may be reassessed weekly, monthly, every three months or annually. The higher the score, the more frequently it will need to be reassessed.
Time spent on the waiting list has not been a factor in liver allocation since the MELD score was introduced. For example, an ill patient with a very high MELD score may be listed and get a liver quickly, “passing” someone who has been on the list for a longer time but has a lower MELD score.
Waiting Time for Liver Transplantation
It is impossible to predict when a liver will become available for transplantation. Patients with higher MELD scores receive liver offers more quickly than patients with lower MELD scores. In general, patients with blood type O or B have the longest wait times, while those with blood type A or AB generally wait a shorter time.
Patients who have living donors do not have to wait until their MELD scores are high to receive a live donor liver transplantation. The timing of their transplantation is based on coordination between the live donor and recipient teams.
Staying Active on the Waiting List
To remain active on the liver transplant waiting list, you must:
- Keep all scheduled appointments
- Get regular laboratory testing according to the schedule you will be given (UNOS regulation)
- Have random drug and alcohol screenings
Communicating with Our Transplant Team
You or a member of your family must contact your liver transplant coordinator or another member of the transplant team regarding any of the following situations. Please contact us right away if you are:
- Admitted to another hospital
- Visit the emergency room
- Receive a diagnosis of an infection of any type
- Change your contact information, including address or phone numbers
- Change your insurance coverage, including prescription plans
- Cannot keep any scheduled appointments at the transplant center
Listing at More Than One Transplant Center
It is permissible for patients to be listed at more than one transplant center simultaneously, but certain restrictions apply. Please discuss the restrictions with our physicians or contact UNOS directly.