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).

Dr. Palmer is an internationally renowned hepatologist who has been practicing medicine since 1985. Prior to 2012, she maintained perhaps the largest medical practice devoted to liver disease in the United States. Dr. Palmer is Clinical Professor of Medicine at New York University Medical Center. Dr. Palmer graduated from Columbia University with a B.A. and was trained in hepatology (as well as medical school) at the Mount Sinai School of Medicine in New York City.

Dr. Palmer is Board Certified in Gastroenterology and in Internal Medicine.

She has authored numerous scientific publications in the field of hepatology in such peer-reviewed journals as Hepatology, Gastroenterology, Seminars of Liver Disease, Transplantation and Archives of Internal Medicine.

She is frequently called upon by the media for her opinion on various topics related to liver disease. Dr. Palmer has appeared many times on television as a liver disease expert and has been quoted in such publications as TIME magazine, Cosmopolitan magazine, Prevention magazine, the Los Angeles Times, and Newsday. She also has appeared in numerous videos and CD-Roms aimed at educating doctors and the public about hepatitis C and other liver diseases, such as primary biliary cirrhosis. Dr. Palmer lectures to the medical and general public on liver disease-related topics on a regular basis.

Dr. Palmer has performed numerous clinical trials on various experimental medications for the treatment of hepatitis.

Dr. Palmer is currently available for lecturing, investor and hedge-fund consultations, consultations to industry, and media interviews and appearances-- including television. For such matters, she can be contacted through hepatitismedia@gmail.com.

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