MODEL FOR END –STAGE LIVER DISEASE: THE MELD SCORE
It was felt by some experts that the former system of liver allocation often did not prioritize patients based on their severity of liver disease. It used geographical region, time spent on the waiting list and some subjective medical criteria (the assessments which are subject to the evaluating doctor’s opinion) to determine placement on the waiting list. But some experts believed that geographical region, as well as time spent on the waiting list should not be taken into consideration. Furthermore, the public became disenchanted with the old method of liver transplant allocation after reading reports of celebrities and sports figures leapfrogging ahead of thousands of regular people (many of whom were on the verge of death) on the transplant waiting list. The shortcomings of the old system led to the institution, as of February 27, 2002 of a new methodology for allocating livers for transplantation. The new system, known as the Model for End-Stage Liver Disease (MELD) score, leaves no room for subjective criteria favoritism or hospital-shopping, as it is based on a mathematical equation. The equation seeks to calculate a patient’s likelihood of dying within three months from their liver disease. In other words under the MELD scoring system - the sickest patient gets the liver transplant.
Three blood tests – the bilirubin, the prothrombin time (PT) - measured as international normalized ratio (INR), and the creatinine (a measure of kidney function) are used to determine this value. The MELD score is calculated using the following equation:
3.8 x log (e) (bilirubin mg/dL) + 11.2 x log (e) (INR) + 9.6 log (e) (creatinine mg/dL)
Don’t let this equation scare you. There are many internet websites that have automatic calculators. All you have to do is to plug in your bilirubin, INR, and creatinine. One such website is the UNOS website- www.unos.org. Other websites which provide an automatic calculator are listed in the appendix of this book page xx.
Scores range from 6-40. A score of six indicates the least ill patient and a score of forty indicates the sickest patient. The MELD score is re-configured many times while the patient is on the transplant waiting list. MELD scores go up and down depending upon the patient’s health. Patients with a diagnosis of liver cancer will be assigned a MELD score based on how advanced the cancer is. This staging system is known as the TNM. T stands for the extent of the tumor, N stands for the presence or absence of lymph nodes, and M stands for the presence or absence of metastasis (tumor spread to another organ such as the lung in the case of liver cancer).
All contents of this article are Copyright © Melissa Palmer, MD
Melissa Palmer, MD is the author of " Dr. Melissa Palmer's Guide of Hepatitis and Liver Disease". (Published 2004. Penguin Putnam).
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