We have a liver selection meeting every Wednesday to consider which patients will get transplants. Each patient is listed by name, age, weight, diagnosis and MELD score - a number, based entirely on lab values, that predicts how bad their liver is and correlates with how likely they are to die waiting for a transplant. A score of 15 is where we start to consider transplantation, and 40 means a 90 percent chance of dying within three months.
Scanning the list, I noticed with discomfort that the patients at the top, with a MELD of 35 or more, had mostly the same diagnoses: alcoholic liver disease; nonalcoholic steatohepatitis, or NASH, a consequence of obesity leading to fatty liver; and an occasional hepatitis C, a virus that was once the most common indication for liver transplant but now is being cured. This was not surprising. These diagnoses make up greater than 60 percent of the national waitlist, and that number continues to grow.
What was making me uncomfortable was that Nate, a medical student on our service, was sitting behind me.
Nate was diagnosed in college with primary sclerosing cholangitis, a rare disease that destroys the liver and leads to irrepressible itching, recurrent infections, possible liver cancer and near-certain death unless a liver transplant is done in time. The problem is, Nate's MELD score remained in the mid-20s - too low to get a liver.
More …
https://www.chicagotribune.com/lifestyles/health/ct-hlth-who-gets-organ-transplants-0221-story.html
