There is a significant gap between the organs available for transplant and the number of people on the liver transplant waiting list, a reliable method of determining the severity of illness is critical to make sure the patients with the greatest need receive priority in the allocation process.
The MELD Scoring System
To address this issue, UNOS uses a formula called the MELD (Model for End-Stage Liver Disease) score that provides a numerical calculation based on the following information:
- How effectively liver excretes bile (Bilirubin). Patients with an elevated bilirubin may have jaundice, or the yellowing of the skin and eyes, due to inability to efficiently remove bile.
- How well the liver can produce blood clotting factors (INR or prothrombin). Patients with altered INR often develop easy bruising and easy bleeding.
- The current function of the kidney (Creatinine)
- An electrolyte that is a marker for significant liver disease (Sodium)
The MELD score ranges from 6 to 40, and is a measure of how severe a patient’s liver disease is. MELD can fluctuate based on your current condition, with variations from a few points as lab values vary to a larger increase if you have an infection or an acute decompensation (worsening of your liver disease).
There is also a system of exception points in place to give increased waitlist priority to patients whose severity of illness or risk of complications are not captured by the MELD score.
Learn more about the MELD exception
Your MELD Score
The frequency of blood tests depends on your MELD score, and these are reported to UNOS to adequately reflect your current need for a liver transplant. The higher the MELD score, the more often you are required to get blood tests – as often as weekly. As a patient’s condition changes, it is important to keep the UNOS database up-to-date with your current MELD score reflecting the urgency of transplant.
Alexa Lustig, MSN RN CCTC, a liver transplant coordinator at Penn, reminds patients, “You don’t need your blood work drawn at Penn. But it is important to communicate with us. We want to make the process easy for you. We know this process is complex, so the more we can allow you to do in the community, the better. Labs can be drawn at a Penn Medicine facility, Quest, Lab Corp or your local lab. The most important factor is to get your labs drawn by their due date and to communicate with our team where they are being done so we can follow up on the results.”
“MELD can be complicated to understand. The easiest way for patients and families to understand it is that it’s a math formula. You enter numbers in, and it spits numbers back out. In general, the sicker your liver is, the higher your MELD, and the higher you are on the transplant list,” Lustig adds.
When patients and their families or caregivers are trying to manage medications, understanding their condition, and then we add transplant into the mix, simplifying things is always helpful.
The MELD Score System at Penn
To help patients remember this critical step in the transplant process, the Penn team will call two weeks before the lab tests need to be done. Since keeping track of appointments and follow-up can be a challenge, another reminder call is made one week before the labs are needed and then a final reminder call is made the day before.
The transplant coordinators work with the transplant medical assistants to ensure all MELD labs are updated on the UNOS waitlist accordingly.
As you get closer to transplant, it is extremely important to make sure labs are done on time so Penn can capture and report accurate MELD scores because this is a critical factor in liver allocation. Additional information about the MELD score and liver allocation is also available from UNOS.
If you would like more information about your MELD score or have questions about the wait list, please contact your pre-transplant nurse coordinator at 215-662-6200.