Previously, patients on the liver transplant waiting list were prioritized to receive a liver transplant according to their “status.” Status depended upon blood tests, signs of severe liver disease, and the amount of time spent on the list.

Now a new scoring system has been developed that is very accurate for predicting survival in adult patients with liver disease. This new system is termed the “Model for End-Stage Liver Disease,” or MELD.

In the MELD system, each person is given a number (“MELD score”), which is determined from three routine lab tests:

• Bilirubin, which measures how effectively the liver makes bile
• INR (prothrombin time), which measures the liver’s ability to make clotting factors
• Creatinine, which measures kidney function, often tied closely to liver function

All patients currently awaiting a liver must undergo periodic testing which will update their MELD status. As a result, individual MELD scores may increase or decrease, depending on the severity of liver disease.

This system assures that donated livers go to the patients in greatest need at that moment. Patients with a higher MELD score will always be considered for a liver transplant before those with lower scores. It is important to understand that the length of time on the waiting list varies considerably from patient to patient.

Under the previous scoring system, waiting time determined the priority for getting a liver transplant among patients of the same status (e.g. Status 2B) and blood type. Under MELD, waiting time will only determine who gets a liver when two or more patients with the same blood type also have the same MELD score.

 

Waiting Period
Once the patient has been through the Liver Transplant Evaluation Session process and the Team has agreed that the patient would benefit from a liver transplant, the waiting process begins.

The patient and referring physician are sent a letter formally confirming that the patient has been placed on the liver transplant waiting list which Jefferson maintains with the  United Network for Organ Sharing (UNOS).

UNOS is the nonprofit organization that is charged with fairly administering the nation’s organ transplant waiting list. Its computers match patients and organs according to objective criteria. For liver transplants,  MELD score is used to prioritize patients according to medical need.

While the patient is awaiting a liver transplant, care for the patient's liver disease will continue under the care of one of Jefferson's hepatologists in collaboration with the liver transplant team and the patient's referring physician. Ongoing evaluation is important to manage the physical effects of chronic liver disease and to keep the patient ready for the upcoming liver transplant.