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Liver Transplant Waiting Lists
last updated:
Tue, 5/18/2010 10:56 AM

One of the most confusing parts of organ transplant is the waitlist. How organs are allocated, or distributed appropriately, is a complex process. Each organ on the transplant list uses a different system for allocation, that is, the way hearts are distributed is different from livers, which is different from kidneys. The allocation of livers for transplantation is based on the Model for End Stage Liver Disease, or MELD, score. The higher the MELD score, the sicker the patient is from their liver disease. 

This score is completely free of human bias and is calculated from three blood tests. These blood tests include creatinine, a measure of kidney function; total bilirubin, a measure of liver function; and INR, a measure of how well the liver is making factors that help the blood clot. These three values are entered into a complex mathematical equation to determine the MELD score. Time on the waitlist only becomes a factor in liver transplantation when two patients have the same MELD score, thus being equally sick, then the patient who has been sicker for a longer time period would get the liver first. Patients can qualify for extra MELD points in a few very defined situations in which the patient’s chance of dying sooner is high. Some of these situations include the presence of liver cancer, low blood sodium or acute liver failure in which the patient will likely die in a few days without a liver transplant.

Once these scores are determined they are entered into a nationwide database of waitlisted patients. The MELD scores are updated on a mandated schedule or when the patient’s condition worsens. When a liver becomes available it is offered within its geographical region to the sickest patients with the corresponding blood type first.

So basically, liver allocation is based on MELD score. A higher MELD score indicates a sicker patient. The higher the MELD score the higher the patient will be on the waiting list and thus more likely to get a donor liver sooner. Liver allocation is a complex process but with the addition of the MELD score as the waitlist criteria there is little room for human bias or “favoritism” in determining who gets the transplant and when.


Amanda Dean is a Nurse Practitioner at the Pre-Transplant Clinic. For more information contact the Methodist University Hospital Transplant Institute in Memphis, Tennessee at All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice. Locate a transplant surgeon in Tennessee or call 888.777.5959 for more information.


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Methodist Healthcare is an integrated health care delivery system, dedicated to the art of healing through our faith-based commitment to minister to the whole person. 1211 Union Avenue, Memphis, Tennessee 38104 • (901) 516-7000