1. 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

2. 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

3. 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.

4. 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

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

6. 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

7. 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

8. 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

9. 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

10. 33,600 The Future 2016 was a record breaking year, as more than
organ transplants occurred in the
United States