MELD Score, Listing for Liver Transplant, and Organ Allocation Donna Ferchill, RN, BSN Clinical Nurse Manager, Liver Transplant Program, Cleveland Clinic Julie Plescia, RN, BSN, CCTC Manager of Organ Services, Lifebanc

Objectives: What is a MELD score? PSC patients and low MELD scores Listing for Liver Transplant Exception points Dual Listing Role of the OPO and UNOS Organ Allocation and Placement

Model for End-Stage Liver Disease (MELD) The Model for End-Stage Liver Disease (MELD) is a reliable measure of mortality risk in patients with end-stage liver disease. It is used as a disease severity index to help prioritize allocation of organs for transplant. These models are for use by medical professionals. MELD scores range from 6 to 40. The MELD score calculation uses: Serum Creatinine (mg/dl)* Bilirubin (mg/dl) INR Serum Sodium (mEq/L) *For patients who have had dialysis twice within the last week, or 24 hours of CVVHD, the creatinine value will be automatically set to 4 mg/dl. PSC patients often have low MELD scores and do not reflect “how sick” these patients are.

LISTING FOR LIVER TRANSPLANT – Formal Liver transplant evaluation completed and patient is deemed candidate for transplant, patient will be listed with chemical MELD score/blood type DUAL LISTING – Per OPTN/UNOS policy patients are allowed to multi list at other transplant centers and also allowed to transfer waiting time EXCEPTION POINTS - some patients with PSC (e.g. those with two documented episodes of cholangitis requiring intravenous antibiotics and hospitalization within one year) are awarded exception points to increase their access to transplantation. UNOS Regional Review Board reviews the submitted exception and if grants exception the patient is given a MELD score of 22

Regional Map To facilitate transplantation, the US is divided into 11 geographic regions.

Lifebanc: Northeast Ohio’s Organ Procurement Organization (OPO) 58 OPOs across the country Independent; non-profit organization Coordinates all organ, eye and tissue donation Bridge between donor hospitals and transplant centers Lifebanc’s Mission: To save and heal lives through organ and tissue donation for transplantation

UNOS: United Network for Organ Sharing Located in Richmond, Virgina Non-profit organization that manages the Nation’s organ transplant system Lifebanc and other OPO’s use the UNOS electronic database to access the National waiting list for organ placement or allocation

Organ Allocation: Placing organs for transplant In general, organs offered: Most critical Locally Regionally  Nationally Livers are allocated by Status 1 needs and MELD score The higher the MELD score, the higher on the waiting list Some organs can be split, some are offered together

Organ Donation: The Need The UNOS waiting list is ever changing, as new patients are added and removed As of yesterday, there were a total of 117,628 patients listed for transplant

33,600 The Future 2016 was a record breaking year, as more than organ transplants occurred in the United States