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Definition of MELD
MELD stands for The Model for End-stage Liver Disease system that was created by the united network for Organ sharing (UNOS), on February 27, 2002, as a way to prioritize patients on the waiting list for a liver transplant.
UNOS is contracted to oversee the National Organ and Procurement and Transportation Network. They are responsible for making sure that the patients on the waiting list receive their livers as prioritized by the Meld scores of each patient.
This system was designed to be fair to all patients and make sure that the ones that are the most ill receive their livers first. A MELD score needed for liver transplant is 20.
Meld, is a numerical scale that ranges from 6 to 40, the number six being less ill and 40 the most critically ill. This system helps determine how emergent the patient's needs are and where they are placed on the waiting list. The score derives from the results of the patient’s most recent laboratory test.
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How is the MELD Score Determined?
There are three standard laboratory tests that are used to determine the MELD score.
• Serum creatinine concentration, indicates if renal Kidney function
• Total serum bilirubin concentration, indicates the presents of jaundice
• International normalized ratio for the prothrombin time. This measures if the blood can clot.
There are four meld levels that break up the scores in a more organized fashion. This helps to determine how ill, the donor patient is.
The four meld levels are:
• Greater than or equal to 25 This level is the more critical
• Less that equal to 10 This level is for the less critical
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How Frequent Are The Laboratory Tests?
The MELD score needed for liver transplant need to be 20 to be considered for liver transplant. The lab test frequency as indicated and required by UNOS is as followed:
Lab Test Frequency:
• MELD score greater than or equal to 25; Labs needed every seven days.
• MELD score 24-19; Labs needed every 30 days.
• MELD score 18-11; Labs needed every 90 days.
• MELD score less than or equal to 10; Labs needed every year.
No one on the transplant team can determine or predict when a liver from a reputable donor will be available for any patient. It is a common policy not to discuss or inform a patient when they are on the list. It is a common practice that the patient is informed of their Meld score and how frequently their laboratory and other additional tests should be done.
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Are There any Exceptions?
There four exceptions that will be assigned higher Meld Scores than that, by the liver transplant patients, laboratory tests. They are liver cancer, Familial Amyloidosis, Hepatopulmonary Syndrome and Primary Oxaluria.
The date of each patient's melds score is recorded in the database. If there are several patients who have the same meld score, then the date they were entered into the database will determine who receives the next liver. The patient who has been waiting for the longest will be a tie breaker. This is the only time that the date entered into the database is used to determine who the next recipient will be.