![]() ![]() The concept of the MELD exception point system is to better capture an individual’s mortality risk. RW Patients who meet certain criteria, such as having hepatocellular carcinoma (HCC), are given MELD exception points (ie, extra points) to increase their priority for receiving a liver transplant. H&O Within the current allocation system, how does hepatocellular carcinoma factor into the MELD score? The Share 35 policy expands the geographic area of organ sharing for patients with MELD scores of 35 or greater before organs are offered to patients with lower MELD scores. Recent changes to the allocation system have attempted to allow broader access to liver transplantation among those with the highest MELD scores. The algorithm for organ distribution is complex, but the concept is that organs that become available are generally offered to patients within the same region as the donor, starting with the most urgent patients first. All revisions of the MELD score aim to improve the accuracy of determining prognosis and, thus, priority for liver transplantation. The MELD score is calculated from a patient’s serum bilirubin level, international normalized ratio, and serum creatinine level, whereas the MELD-Na score is a recently adopted, modified MELD score that incorporates serum sodium. This allocation system uses objective measures based upon laboratory tests (ie, MELD and MELD-Na scores) to determine the severity of liver disease. The overarching goal is to provide liver transplants first to the sickest patients, who are the ones in greatest need. RW The current allocation system for patients with chronic liver disease is based upon patients’ Model for End-Stage Liver Disease (MELD) score and allocates organs across 11 geographic regions in the United States. H&O How are donor livers currently allocated to patients in need of a transplant? Clinical Advances in Hematology & Oncologyĭivision of Gastroenterology and Hepatology ![]()
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