Liver Transplantation: Understanding the MELD Score

If you’re a liver transplant patient, you’ve likely heard your doctors talk about your MELD score. Having a strong understanding of your MELD score and how it’s calculated is important because it often influences how long you’ll wait for your liver transplant. We’ve put together this blog post to help answer the most frequently asked questions about the MELD score.

What is the MELD score?

MELD is an acronym for model for end-stage liver disease, and MELD score is the score provided to patients based on how urgently they need a liver transplant in the next three months. It’s used by hospitals and the government to prioritize allocation of deceased donor livers for transplant. The MELD score can range from 6 (less ill) to 40 (gravely ill). The same MELD score definition and calculation are used by all transplant centers in the U.S. MELD scores are kept in a national database managed by the United Network for Organ Sharing (UNOS), an agency contracted by the government to manage the organ transplant waiting lists. You can get an overview of the MELD score in this video.

Why is the MELD score needed?

As of today, there are over 10,000 people waiting for a liver transplant, and there are not enough deceased donor livers to meet that need. The MELD score was developed so the sickest patients get the first livers available. The MELD score helps hospitals maintain fair lists across the nation so the livers that become available can go to those patients with the most urgent need.

How is my MELD score calculated?

Since your health condition can change frequently, your doctor will send you to the lab for updated blood work routinely, so they can assess your condition often. The results of your blood work are used to calculate your score for the waiting list. When your updated blood work is delivered to your doctor, the transplant team will calculate your MELD score using an online calculator and submit the changes to UNOS directly. You may have several changes to your score during your time on the wait list. Your care team will notify you of any major changes to your list status.

Your MELD score is calculated using five blood test results — bilirubin, serum sodium, INR, albumin and serum creatinine. These results are entered into a mathematical formula using the UNOS MELD score calculator. In some cases there may be special circumstances such as certain liver cancers that are not taken into account during your score calculation. In case of a medical condition that is not covered by the MELD score, if your care team believes your case qualifies for an exception, they can submit information to a review board and request a higher score. These exceptions rarely happen, but in some cases, the review board will grant a higher score.

I’m at the top of the list. Will I get the next liver?

Your position on the waiting list can change quickly, and your care team keeps close track of these numbers and will let you know when you are near the top of the list. Remember, not every liver goes to the first person on the waiting list. Liver allocation is a complex process, and MELD score is just one of the variables doctors use to determine who receives the next available liver.

In the case of living donor liver transplant, your medical team may still calculate a MELD score and place you on the transplant waiting list, but the time of your transplant will be determined by your doctors and a number of factors, not necessarily by your score on the waiting list.

Most transplant patients follow their MELD scores and have a general idea of where they stand on the waiting list. If you’d like more information about your score and position on the list, speak to your transplant team.

If you’ve had a transplant, when you made it to the top of the list, what was your reaction to knowing that the next organ might be yours?

HELPFUL LINKS

• Read about liver transplant at Mayo Clinic.
• Explore Mayo’s Transplant Center.
• Request an appointment.