Liver Transplant Evaluation and Assessment Guide

Model for End stage Liver Disease (MELD)

MELD is used to prioritise and allocate adult patients waiting for a liver transplant. It is based on a statistical formula that predicts which individuals are most likely to die from their liver disease.

Patients waiting for liver transplantation need a donor with the same blood group as the recipient. It is also important to have a good size match between the donor liver and you, the recipient.

What is MELD and how will it be used?

MELD is a numerical scale, ranging from 6 which is less ill to 40 which is gravely ill. It gives each patient a ‘score’ or number based on how urgent he or she needs a liver transplant in the next 3 months. Research has shown that MELD accurately predicts most patient’s short-term risk of

death without a liver transplant. The MELD score is also used to identify patients who are too well and do not need a liver transplant.

The number is calculated by a formula using 3 routine laboratory test results:

• Bilirubin, which measures how effectively the liver excretes bile.
• INR, prothrombin time, which measures the liver’s ability to make blood clotting factors; and
• Creatinine, which measures kidney function. Poor kidney function is often associated with severe liver disease.

The majority of patients waiting for a liver transplantation have chronic liver disease and are listed as Category 3 and have their MELD score calculated regularly. A patient’s MELD score may go up or down over time depending on the status of his or her liver disease. Your MELD score will be assessed monthly whilst you are on the waiting list. This will help ensure that livers go to the sickest patient, that is the person in greatest need at that time.

Category 1 and 2 patients have acute liver failure and a very short life expectancy without a transplant. These patients have the highest priority to receive an organ and are not affected by the MELD system.

In this guide:

1. Information and contact details for the liver transplant hepatology team
2. The liver - its function and anatomy
3. Signs of liver disease
4. Pre-transplant assessment and evaluation
5. The assessment team
6. Allied Health Services
7. Palliative care
8. Pharmacy—medications before your transplant
9. Case discussion and assessment presentation
10. Will I make the list?
11. The liver transplant waiting list
12. Model for End stage Liver Disease (MELD)
13. Support Through Education Program (STEP)
14. The Donor
15. What happens when you are notified that a donor liver is available?
16. The liver transplant operation
17. Intensive Care Unit (ICU) patient information
18. The recovery period
19. Pharmacy—medications after your transplant
20. Rejection
21. Donor family correspondence and information
22. Glossary

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