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Nov 14, 2017

The MELD Score: Definitions and Frequently Asked Questions

By Mayo Clinic Transplant Staff, @mayoclinictransplantstaff

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.

Why is the MELD score needed?

As of today, there are over 14,000 people waiting for a liver transplant, and there are not enough deceased donor livers to meet that need. The MELD score was put into place 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? 2017-11-13 MELD Score Calculator

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 four blood test results — bilirubin, serum sodium, INR 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, not 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.

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

 

@mayoclinictransplantstaff Interesting article. Coincidentally, the cousin of my dauhter’s fiancé was one of the team who developed the MELD score. I hope he will be at her wedding so I can talk to him about it.
Another component of who gets the next liver is Blood Type of course. Being a B was in my favor.
I thought the doctors basically had to abide by the list, what type of input/discretion are they allowed? I was never told I was near the top of the list, at 28 in Boston I was under the impresssion it would be at least a couple of more months. My husband thinks I got it sooner because I worked hard at getting in better shape and losing weight so I was a promising candidate, and would do well after a transplant, which I did.
I think if I thought I was near the top of the list I would have been nervous. As it was, the call was a huge suprise and we took off for Boston, perfectly calm! No time to be nervous. It seems so long ago in some ways and just like yesterday in others. I feel so extremely fortunate.
JK

COMMENT

With a MELD score of 39 in late December of 2018, I was told I was at the top of the list but was also experiencing kidney failure. My MELD was brought down to 34 and was released from Mayo Florida’s Hospital by the end of January 2019. Strangely I was happy to hear about my place on the list but also was very ill. I was readmitted a week later in very poor condition with a MELD of 44. Later that night my MELD was 47 and was extremely ill with terrible fatigue, chills, and was unable to eat much. Then received the news that a liver was available and I would have a transplant during the night into the next morning. I was not afraid but glad that I had the chance of getting a new liver. Initially I thought it would take about 2 years to possibly get a transplant when my MELD was only a 10. It actually turned out to be 8 months from the diagnosis and 1 month after being listed. Thank you Liver Teams for a chance of a longer life!

COMMENT
@flagal22

With a MELD score of 39 in late December of 2018, I was told I was at the top of the list but was also experiencing kidney failure. My MELD was brought down to 34 and was released from Mayo Florida’s Hospital by the end of January 2019. Strangely I was happy to hear about my place on the list but also was very ill. I was readmitted a week later in very poor condition with a MELD of 44. Later that night my MELD was 47 and was extremely ill with terrible fatigue, chills, and was unable to eat much. Then received the news that a liver was available and I would have a transplant during the night into the next morning. I was not afraid but glad that I had the chance of getting a new liver. Initially I thought it would take about 2 years to possibly get a transplant when my MELD was only a 10. It actually turned out to be 8 months from the diagnosis and 1 month after being listed. Thank you Liver Teams for a chance of a longer life!

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@flagal22 Congratulations on your transplant. I have never heard of such a high MELD score! It’s no wonder that your transplant occurred much sooner than anticipated when you started with a MELD 10.
My transplant happened when my MELD was 28 but it was about to be re-evaluated and I am sure it would have increased at that point. I was pretty miserable when the call came, so like you there was no fear or apprehension, just relief.
The gratitude I have for feeling well is immense. I have been great ever since my transplant. It sounds as if you have also, that’s wonderful.
JK

COMMENT
@flagal22

With a MELD score of 39 in late December of 2018, I was told I was at the top of the list but was also experiencing kidney failure. My MELD was brought down to 34 and was released from Mayo Florida’s Hospital by the end of January 2019. Strangely I was happy to hear about my place on the list but also was very ill. I was readmitted a week later in very poor condition with a MELD of 44. Later that night my MELD was 47 and was extremely ill with terrible fatigue, chills, and was unable to eat much. Then received the news that a liver was available and I would have a transplant during the night into the next morning. I was not afraid but glad that I had the chance of getting a new liver. Initially I thought it would take about 2 years to possibly get a transplant when my MELD was only a 10. It actually turned out to be 8 months from the diagnosis and 1 month after being listed. Thank you Liver Teams for a chance of a longer life!

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@flagal22, Thank you for what you have shared. As I read your account of your experience, I could feel myself in your place 10 years ago, except that I needed to have a kidney transplant along with my liver transplant. I hope that you will enjoy many years of a healthy life and I echo your words of gratitude, "Thank you Liver Teams for a chance of a longer life!"

COMMENT
@contentandwell

@flagal22 Congratulations on your transplant. I have never heard of such a high MELD score! It’s no wonder that your transplant occurred much sooner than anticipated when you started with a MELD 10.
My transplant happened when my MELD was 28 but it was about to be re-evaluated and I am sure it would have increased at that point. I was pretty miserable when the call came, so like you there was no fear or apprehension, just relief.
The gratitude I have for feeling well is immense. I have been great ever since my transplant. It sounds as if you have also, that’s wonderful.
JK

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@contentandwell Thank you for your well wishes! I did not know the MELD score could go over 40 either, until meeting 2 liver transplant recipients by chance while waiting for an appointment at Mayo. They both came to Mayo in Jacksonville after being treated at hospitals near their homes. They told me there stories of having MELD scores over 40 and receiving their transplants in about 1 week after arriving at Mayo. Take care!

COMMENT
@rosemarya

@flagal22, Thank you for what you have shared. As I read your account of your experience, I could feel myself in your place 10 years ago, except that I needed to have a kidney transplant along with my liver transplant. I hope that you will enjoy many years of a healthy life and I echo your words of gratitude, "Thank you Liver Teams for a chance of a longer life!"

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@rosemarya Thank you! I almost had to have a liver and kidney transplant because I was hospitalized 3 times for kidney failure but they got my kidney issue straightened out before my transplant.

COMMENT
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