If you’re an adult with liver disease that may call for a transplant, your MELD score helps to tell how quickly you might need it.
MELD stands for "model for end-stage liver disease." (Doctors use a different system, called PELD, for children younger than 12.)
A MELD score is a number that ranges from 6 to 40, based on lab tests. It ranks your degree of sickness, which shows how much you need a liver transplant. The higher the number, the more urgent your case is.
Reasons why you might need a liver transplant include having conditions that cause liver failure, such as:
- Alcoholic liver disease
- Wilson's disease
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
- Biliary atresia
If your doctor says you need a liver transplant, you’ll be added to a waiting list managed by a national organization called the United Network for Organ Sharing. Your MELD score is one of several things that tells your place on the list.
Making a MELD Score
Your MELD score is based on results from several lab tests, including your:
- Creatinine level, which is related to how well your kidneys are working
- Bilirubin level, which shows how well your liver clears a substance called bile
- INR (international normalized ratio), which reflects how well your liver makes factors needed for blood clots
- Serum sodium level, which shows the concentration of sodium in your blood
You’ll get your MELD score recalculated from time to time. Your medical condition, treatment, and previous MELD score all affect how often that’s done.
If your MELD score is:
- Under 10: It will be recalculated once a year.
- 11-18: It will be recalculated every 3 months.
- 19-24: It will be recalculated once a month.
- 25 or higher: It will be recalculated every week.
To learn about your MELD score, you can talk with your doctor or enter your most recent lab results into a calculator on the Organ Procurement and Transplantation Network’s website.
MELD Isn’t Everything
A MELD score alone can’t predict your wait time on the transplant list. Other things also affect when you could be offered a liver, including
- The supply of, and demand for, livers in your region
- How close you are, geographically, to the donated liver
- Blood type
- Body size
- Donor’s age
If a transplant center believes that your MELD score doesn’t accurately represent how urgently you need a liver transplant, it can try to add “exception points” to your score. To do this, it submits paperwork to a regional review board. Conditions that call for exception points include:
- Cystic fibrosis
- Familial amyloid polyneuropathy (FAP)
- Hepatic artery thrombosis (HAT)
- Hepatocellular carcinoma (HCC)
- Hepatopulmonary syndrome (HPS)
- Metabolic disease
- Portopulmonary hypertension
- Primary hyperoxaluria
The transplant center must update information about your exception points every 3 months.
In a crisis, you may get a special priority status called Status 1A. This happens if your doctor believes that you may only have hours or days before you need a transplant to live.