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Who is a candidate for a liver transplant?

To determine who is in the most critical need of a liver transplant, the United Network for Organ Sharing (UNOS) uses a system in the US that includes the Model for End-Stage Liver Disease (MELD) scoring system for adults and the Pediatric End-Stage Liver Disease (PELD) scoring system for children under 18 years of age. These scoring methods were set up so that donor livers could be distributed to those who need them most urgently, not just who had been on the waiting list the

longest.

In early 2002, UNOS enacted a major modification to the way in which people were assigned the need for a liver transplant. Previously, patients awaiting livers were ranked as status 1, 2A, 2B, and 3, according to the severity of their current disease. Although the status 1 listing has remained, all other patients are now classified using the Model for End-Stage Liver Disease (MELD) scoring system if they are aged 18 years or older, or the Pediatric End-Stage Liver Disease (PELD) scoring system if they are younger than 18 years. These scoring methods were set up so that donor livers could be distributed to those who need them most urgently.

Status 1 (acute severe disease) is defined as a patient with only recent development of liver disease who is in the intensive care unit of the hospital with a life expectancy without a liver transplant of fewer than 7 days.

MELD scoring: This system is based on the risk or probability of death within 3 months if the patient does not receive a transplant. The MELD score is calculated based only on laboratory data in order to be as objective as possible. The laboratory values used are a patient’s creatinine, bilirubin, and international normalized ratio, or INR (a measure of blood-clotting time). A patient’s score can range from 6 to 40. In the event of a liver becoming available to 2 patients with the same MELD score and blood type, time on the waiting list becomes the deciding factor.

PELD scoring: This system is based on the risk or probability of death within 3 months if the patient does not receive a transplant. The PELD score is calculated based on laboratory data and growth parameters. The laboratory values used are a patient’s albumin, bilirubin, and INR (measure of blood-clotting capability). These values are used together with the patient’s degree of growth failure to determine a score that can range from 6 to 40. As with the adult system, if a liver were to become available to two similarly sized patients with the same PELD score and blood type, the child who has been on the waiting list the longest will get the liver.

Based on this system, livers are first offered locally to status 1 patients, then according to patients with the highest MELD or PELD scores. Next, if there are no local recipients, the liver is offered regionally, in the same order, and finally, on a national level.

Status 7 (inactive) is defined as patients who are considered to be temporarily unsuitable for transplantation.

More information on liver transplant

What is a liver transplant? - Liver transplant is a surgical procedure performed to replace a diseased liver with a healthy liver from another person. An entire liver may be transplanted, or just a section.
Who is a candidate for a liver transplant? - To determine who is in the most critical need of a liver transplant, the United Network for Organ Sharing (UNOS) uses a system.
Where do donated livers come from? - Liver donors are usually persons who have died and whose families have consented to having their organ donated.
How are transplanted organs allocated? - The United Network for Organ Sharing is responsible for transplant organ distribution in the United States.
How is liver transplant surgery performed? - There are three types of liver transplantation methods. They're orthotopic transplantation, heterotopic transplantation, and reduced-size liver transplants.
How to recover from liver transplant surgery? - Patients with transplanted livers have to stay on immunosuppressant drugs for the rest of their lives to prevent organ rejection.
What're the complications of liver transplantation? - There are several complications that can affect a recipient of a liver transplant. Major bleeding is common after transplantation.
What medications are used for liver transplant? - Liver transplant recipients are prescribed immunosuppressive medications to prevent rejection and antibiotics to prevent infections. 
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