The local federally designated Organ Procurement Organization, California Transplant Donor Network (CTDN), facilitates equitable distribution of donor livers between the local liver transplant centers (Stanford, CPMC and University of California, San Francisco). CTDN acts as a bridge between a donor hospital (a hospital with a patient who is an organ donor) and the local transplant centers. It is the policy of UNOS that all potential recipients of organ transplants must be listed on the national UNOS computer waiting list, with the priority for a donor organ determined by factors discussed below.
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What is MELD? How will it be used?
The Model for End-Sage Liver Disease (MELD) system was implemented February 27, 2002 to prioritize patients waiting for a liver transplant. MELD is a numerical scale used for adult liver transplant candidates. The range is from 6 (less ill) to 40 (gravely ill). The individual score determines how urgently a patient needs a liver transplant within the next three months. The number is calculated using the most recent laboratory tests.
Lab values used in the MELD calculation:
- Bilirubin, which measures how effectively the liver excretes bile;
- INR (formally known as the prothrombin time), measures the liver’s ability to make blood clotting factors;
- Creatinine, which measures kidney function. Impaired kidney function is often associated with severe liver disease.
Within the MELD continuous disease severity scale, there are four levels. As the MELD score increases, and the patient moves up to a new level, a new waiting time clock starts. Waiting time is carried backwards but not forward. If a patient moves to a lower MELD score, the waiting time accumulated at the higher score remains. When a patient moves to a higher MELD score, the waiting time at the lower level is not carried to the new level. The clock at the new level starts at 0. (Example: Patient has a MELD score of 15 and has been at level 11-18 for 100 days. With new laboratory tests, the patient’s MELD score is 22. The patient moves to a new MELD level of 19-24. The patient’s waiting time at this new level starts at 0 days). Waiting time is only used as a tie-breaker when patients have the same MELD score.
The four MELD levels are:
- greater than or equal to 25
- 24-19
- 18-11
- less than or equal to 10
