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Patient Selection Criteria

                                                                                  Liver Transplantation: Version 7.0

Patient Selection Criteria

Patient selection criteria are based on severity of illness.  Status 1A patients are the sickest and are those who are not expected to live more than seven days without a liver transplant.  An example of a Status 1A patient would be someone who has fulminant hepatic failure secondary to acetaminophen (Tylenol) overdose.  These patients are hospitalized in the ICU awaiting a transplant.  The remaining patients are categorized by the Model for End-stage Liver Disease (MELD) score or Pediatric End-stage Liver Disease (PELD) score that was adopted by UNOS in February 2002.  The factors used to calculate the MELD/PELD score are: INR, bilirubin, creatinine, and serum sodium for patients > 12 years of age and bilirubin, INR, albumin, height, and weight for children < 12 years of age.  These are related through a complex calculation that yields a numeric score from six to 40. The MELD/PELD score is predictive of death within three months.  Patients are listed according to their MELD/PELD scores.  

To calculate the MELD/PELD score for your member go to the Allocation Calculator. This tool allows you to calculate the MELD/PELD score if you have the pertinent laboratory results available to you.  Patients with MELD/PELD scores less than 16 typically will not gain a survival advantage with transplantation. Patients without hepatocellular carcinoma are typically transplanted with MELD/PELD scores of 19 to 28. Patients are reevaluated frequently (at least every three months) and their MELD/PELD scores updated accordingly.

Refer to the “What’s New?” section for a detailed discussion of the UNOS organ allocation system and recent changes that will affect how your member is listed. Because of the fact that patients are offered livers based on the severity scoring, time on the waitlist is not terribly important: the sickest patients will generally get livers. Thus, the center you are working with may not choose to list the patient until they know that the patient has a MELD/PELD score >= 16.