The MELD Score and Transplant Basics
Once it has been determined that patient needs a liver transplant, the patient must go through a battery of tests to access their health in other areas. These test include an EKG, an MRI, a bubble-echo, Hepatitis testing, stress tests, and other tests depending on the patient’s age and medical history. The patient will also be interviewed by a social worker, a psychiatrist, a hepatologist, a financial coordinator, and a nurse practitioner.
These tests and interviews are administered to make sure that the patient is physically fit for the transplant, that the patient will be able to afford the medical expenses, and has a support system during recovery. These tests and interviews are to help the medical team prepare the patient for an efficient transplant and recovery.
At this point, the doctors calculate the patient’s MELD score (The Model of End-Stage Live Disease score). This score is based on the patient’s bilirubin levels, INR (a measurement of the liver’s ability to produce coagulants), and creatinine levels (measurement of kidney function as kidney function is often related to liver function). The score ranges from 0-40, with 40 being the most severe and decides the patient’s place on the transplant waiting list.
Because Ella’s liver is currently performing most necessary functions, her MELD score was originally at a 6, even with the bile drains protruding from her chest. The factors that contribute to a MELD score do not account for certain liver dysfunctions, such as Ella’s clogged bile ducts. Thus, Ella’s doctors applied for exception points by stating her case to UNOS (The United Network for Organ Sharing), the agency that is responsible for the disbursement of allocated organs nationwide. The doctors made a case that because of the tubes, Ella would have bouts of cholangitis, or infections of the bile ducts. She was then granted a score of 25.
However, as Ella’s condition worsens, her score does not go any higher. Every three months, she may be allotted three extra points under the assumption that her case has gotten worse. Unfortunately, Ella’s case is getting worse at a faster pace than her score reflects.
Thus, members of Ella’s friend and family have volunteered to be live donors.