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Thursday, September 19, 2013

Understanding the MELD Score

The United Network of Organ Sharing (UNOS) reported last year that there were approximately 700 people in the greater Philadelphia region on the liver transplant waiting list. However, only 376 organ donors were able to donate a liver.

Because there is a significant gap between the organs available for transplant and the number of people on the liver transplant waiting list, a reliable method of determining the severity of the liver disease is critical to make sure the patients with the greatest need receive priority in the allocation process.

What is a MELD Score?

To address this issue, UNOS uses an algorithm called the MELD (Model for End-Stage Liver Disease) score that makes a numerical calculation based on the following information:
  • How effectively liver excretes bile (bilirubin)
  • How well the liver can blood clotting factors (INR or prothrombin)
  • The current function of the kidney (creatinine) 

The MELD score changes over time depending on the course of the chronic liver disease and ranges from 6 to 40 - with the most gravely ill patients having the highest numbers. Routine blood tests determine the MELD score and are reported to UNOS to accurately record a patient’s current need for a liver transplant. The frequency of the blood tests depends on the severity of the liver disease – as the disease worsens, more blood tests are required to keep the UNOS database as up-to-date as possible on a patient’s condition.

“Liver transplant patients are often overwhelmed or confused by the description of the MELD score,” according to Colleen Cook, BSN, RN, a liver transplant coordinator Penn. She offers a simple explanation to simplify understanding what this score means for patients.

“An easy way to think about the MELD score and explain it to your friends and family members is: the MELD score is how sick the liver is, and the sicker the liver is, the higher the number, which means you are closer to transplant,” says Cook.

Another important thing for patients to remember regarding the MELD score is to always be sure to let the transplant team know when and where you are planning to have your blood test done. This is because UNOS requires that patients with a MELD score of 25 or higher submit lab results within 48 hours of the blood test being completed. With this in mind, due to lab processing timeframes, it’s not advisable to have blood drawn on Friday because lab reports could be delayed until Monday, which would not be sufficient for UNOS requirements.

“We have a great system in place to support patients with this process,” said Cook. “Our medical assistants contact patients several times to remind them of when to have their blood drawn for the MELD score.”

To help patients remember this critical step in the transplant process, the Penn team will call two weeks before the lab test needs to be done. Since keeping track of appointments and follow-up can be a challenge, another reminder call is made one week before the lab is needed and then a final reminder call is made the day before.

As you get closer to transplant, it is extremely important to make sure labs are done on time so Penn can capture and report accurate MELD scores because this is a critical factor in liver allocation. Additional information about the MELD score and liver allocation is also available from UNOS.

If you’d like specific information about your MELD score please contact your pre-transplant nurse coordinator at 215-662-6200.

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