A scoring system has been developed that is very accurate for predicting survival in adult patients with liver disease. This system is termed the Model for End-Stage Liver Disease, or MELD. 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.
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
If you are currently awaiting a liver, you must undergo periodic testing to update your 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. If you have a higher MELD score, you 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.
Waiting Period for a Liver Transplant
Once you have been through the liver transplant evaluation and the team has agreed that you would benefit from a liver transplant, the waiting process begins.
You and your referring physician are sent a letter formally confirming that you have 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 responsible for 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 you are awaiting a liver transplant, care for your liver disease will continue under Jefferson hepatologists in collaboration with the Liver Transplant team and your referring physician. Ongoing evaluation is important to manage the physical effects of chronic liver disease and to keep you ready for the upcoming liver transplant.