For patients being evaluated for a liver transplant, the Model for End-Stage Liver Disease (MELD) score is a key tool used to assess how urgently a transplant is needed. This score helps determine priority on the deceased-donor liver waiting list.
In adults aged 18 years and above, MELD scores typically range from 6 to 40, with higher scores indicating more severe liver disease.
The MELD score is a numerical value that estimates the short-term risk of death in patients with advanced liver disease. It allows transplant authorities to objectively prioritise patients based on medical urgency rather than waiting time alone.
Allocation of deceased-donor livers is guided by policies set by the Organ Procurement and Transplantation Network, ensuring that the sickest patients receive organs first.
Patients awaiting liver transplantation may fall into one of the following categories:
Reserved for patients with sudden, severe liver failure where survival without a transplant is measured in hours to days.
A score derived from laboratory values and updated periodically while a patient remains on the waiting list.
In certain conditions, standard MELD calculations may underestimate disease severity. Exception points may be granted for conditions such as selected liver cancers, hepatopulmonary syndrome, or other recognised disease-specific situations.
Patients who are temporarily not eligible for a deceased-donor transplant due to medical or non-medical reasons.
The MELD score is calculated using results from specific blood tests that reflect how well vital organs are functioning.
These include:
Together, these values provide an objective measure of disease severity.
The MELD score estimates the likelihood of survival over the next three months. A higher score means greater urgency and a higher chance of receiving a deceased-donor liver when one becomes available.
The allocation system is designed so that patients with the most severe illness—typically those with MELD scores between 30 and 40—are prioritised first.
As the score increases, so does transplant priority.
Your MELD score is recalculated by your medical team based on changes in your condition. Patients are not responsible for updating their own score.
The frequency of recalculation depends on how advanced the liver disease is:
Regular follow-up visits and timely laboratory tests are essential to ensure your score accurately reflects your current condition.
While the MELD score is central to organ allocation, other factors also play a role, including:
These factors help ensure safe and effective transplantation.
Patients with low MELD scores (below 15) are often less likely to receive a deceased-donor liver through standard allocation systems, even though they may have significant symptoms or reduced quality of life.
For such patients, living-donor liver transplantation can be a valuable and life-saving option. It allows transplantation to occur earlier, rather than waiting for disease severity to increase.
Importantly, some patients may be sicker than their MELD score suggests, and individual clinical judgement plays a crucial role in transplant decision-making.
The MELD score is a powerful tool used to prioritise liver transplant candidates based on medical urgency. However, it is only one part of a comprehensive evaluation.
Regular monitoring, close communication with your transplant team, and timely follow-up are essential to ensure optimal care and appropriate transplant planning.
If you have questions about your MELD score or transplant eligibility, discuss them with your hepatologist or transplant coordinator.
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