Expert Answers: What is MELD & why do we need it?
The term “MELD” score is commonly heard in those with Hepatitis C, but many people don’t understand what it means. We’ve had several people ask us to explain the MELD score in laymen terms, so we asked our expert, Sue.
Here’s what Sue had to say:
The MELD score, is the acronym for the Model for End-Stage Liver Disease. It is considered an accurate numerical scale for measuring the risk of patient mortality in the following three months, in patients 12 years and older. The MELD score helps doctors decide where to place patients on the liver transplant waiting list. The number assigned to each patient ranges from 6 to 40. Patients with the highest scores are the sickest and go to the top of the list. The MELD score is usually one of four factors in determining if and when the patient gets a liver. The other factors are the patient’s blood type and body size, as well as the urgency of the patient’s need. For patients under the age of 12, the PELD (Pediatric End-Stage Liver Disease) score is used.
The score is calculated using three factors. Bilirubin, prothombin time (how long it takes blood to clot) also known as INR, and creatinine, are the laboratory values that are used. The MELD calculator can be found here.
MELD scores vary and the patient will most likely have his MELD score calculated a number of times while he is waiting for that important call that a liver is available. The only exception to the MELD score is a patient who is suddenly and acutely ill and has less than a few hours to a couple of days to live without a transplant. These patients are considered Status 1 patients and go right to the top of the list.
Donor livers are offered to patients depending on the severity of their liver disease and if the organ is in the region where the patient is located. If there is no match in the local region, the liver is offered to a patient in a wider region and if not needed, it is offered to patients nationwide. Bear in mind that Status 1 patients are always offered the liver before anyone else. Next in line are patients with MELD scores over 14 and lastly, if no matches are found, patients with MELD scores less than 14 may be offered the organ.
Organ transplantation is overseen by the U.S. Department of Health and Human Services (DHHS, Division of Transplantation). They contract with United Network for Organ Sharing (UNOS). Amongst the many things that UNOS is responsible for are managing the waiting list that matches donors to recipients and maintaining the database. They also make sure that all policies are followed and the system is as fair and equitable as it can be.
We urge everyone to become an organ donor. Even patients with hepatitis C may be organ donors as their organs may be used successfully in hepatitis C positive patients who are awaiting this beautiful gift of life.