How does the waiting list for liver transplant work?

Deborah Davis
OBGYN (Obstetrics & Gynecology)
If you become an active liver transplant candidate, your name will be placed on a waiting list.  Patients are listed according to blood type, body size, and medical condition (how ill they are).  Each patient is given a priority score based on three simple blood tests (creatinine, bilirubin, and INR). The score is known as the MELD (model of end stage liver disease) score in adults and PELD (pediatric end stage liver disease)in children.  Patients with the highest scores are transplanted first.  As they become more ill, their scores will increase and therefore their priority for transplant increases, allowing for the sickest patients to be transplanted first.  A small group of patients who are critically ill from acute liver disease have the highest priority on the waiting list.  It is impossible to predit how long a patient will wait for a liver to become available.  Your transplant coordinator is always available to discuss where you are on the waiting list.
The severity of liver disease in patients waiting for transplants ranges from having mild complications to being critically ill in the intensive care unit. United Network for Organ Sharing (UNOS) has developed a scoring system known as the Model for End-stage Liver Disease, or MELD, in which the sickest patients are given priority for organ allocation. Every center in the U.S. must follow the UNOS MELD system.

The MELD system involves a numerical scale, ranging from 6 (less ill) to 40 (gravely ill), used for liver transplant candidates age 12 and older. It gives each person a "score" (number) based on how urgently he or she needs a liver transplant within the next three months. The number is calculated by a formula using three routine lab test results:
  • Bilirubin, which measures how effectively the liver excretes bile;
  • INR (prothrombin time), which measures the liver's ability to make blood clotting factors; and
  • Creatinine, which measures kidney function. (Impaired kidney function is often associated with severe liver disease.)
The only priority exception to MELD is a category known as Status 1. Status 1 patients have acute (sudden and severe onset) liver failure and a life expectancy of hours to a few days without a transplant. Less than one percent of liver transplant candidates are in this category. All other liver candidates age 12 and older are prioritized by the MELD system. Candidates age 11 and younger are placed in categories according to the Pediatric End-stage Liver Disease (PELD) scoring system. A MELD/PELD brochure and calculator are available on the UNOS website.

Once potential liver transplant candidates are approved by the liver transplant team and have financial clearance, they are placed on the United Network for Organ Sharing (UNOS) waiting list. UNOS is the agency authorized by the federal government to maintain the database for all transplant recipients in the United States.

Being placed on a waiting list means that a candidate’s name and certain medical information are entered into a national database maintained by UNOS. In our area, donor livers are allocated by UNOS and the regional organ procurement organization, Gift of Life Donor Program. Suitable donors have a compatible blood type, and size may be a factor as well. Each donor is evaluated carefully by the Gift of Life and the transplant surgeons.

Since the list is based on medical urgency, a person's position on the list may fluctuate based on his or her health status and as other people are listed and transplanted.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.