MELD (Model for End Stage Liver Disease) is a system of measuring the severity of chronic liver disease. Not only is it important in determining the need for a liver transplant, as well as the allocation of deceased donor livers, but it’s also highly correlated with recipient survival and improvement post-transplant.
In 2005, the Scientific Registry of Transplant Recipients (SRTR) reported that the likelihood of recipient death from transplant related complications was substantially higher if the recipient had a MELD score of 14 or less than if not receiving a transplant. Once the recipient’s MELD score was 15 or more, a liver transplant improved the likelihood for the patient to live 1 year or more. Consequently, since 2006, UNOS rules have mandated that livers be offered to all patients with MELD scores of 15 or more across the region before allowing livers to be used for local recipients with a MELD score of 14 or less.(115)
Abstract #86 at the 2006 World Transplant Congress confirms: Based on one year post-transplant follow-up, patients in low MELD categories did not demonstrate survival benefit from transplant. (117)
It’s safe to say that physicians don’t want their patients to die. And for severe liver disease, the only treatment is transplant. Consequently, some doctors fail to adequately explain the connection between MELD and patient prognosis (the probability a patient will have a good or bad outcome from a specific treatment) when encouraging a would-be recipient to find a living donor because they are ineligible or highly unlikely to receive a deceased donor liver.
While attending scientific sessions on living donor liver transplantation during national and international meetings, we are informed that the recipients’ MELDs were 13, 12 or even 6 (10,11) or that the recipients had tumors well outside accepted criteria believed to justify the use of a deceased donor (12). (115)
Some centers consider living donor transplantation for patients with diseases disadvantaged by the current deceased donor liver allocation system (advanced hepatocellular carcinoma, metastatic neuroendocrine cancer, polycystic liver disease, etc).(156)
In other words, recipients who would not qualify for a deceased donor liver because the odds of graft or recipient survival are too low are being given living donor livers. Live liver donors, who experience a 40% complication rate and who have to live with the unknown consequences of the procedure, are treated with less regard or consideration than deceased donor livers.
Among the recipients [of 449 adult-to-adult living liver donor transplants in the US],1.6 percent did not meet criteria for receipt of a cadaveric transplant. (125)
If you or someone you know is considering becoming a living liver donor, obtain as much information as possible on the would-be recipient’s condition, including the MELD score, before making your decision.
The most current OPTN policies on deceased liver allocation can be found here.
Last Updated: March 7, 2013