Understanding Your MELD Score for Liver Transplant

The Organ Procurement and Transplantation Network (OPTN) decides the criteria for those selected for the liver transplant waiting list. Liver transplant candidates, ages 18 and older, will receive a model for end-stage liver disease (MELD) score between 6 and 40.

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What Is Your MELD Score?

If you are a candidate for a liver transplant, a MELD score helps determine how urgently you need a transplant. It is used to determine your status on the deceased-donor liver waiting list. 

Liver transplant candidates can be assigned any of the following MELD statuses:

• Status 1A — Sudden and severe onset of liver failure and life expectancy of hours to days without a liver transplant.
• Calculated MELD score — MELD score calculated from lab values. This score is updated periodically while awaiting transplant.
• MELD exception score — MELD exemptions may be granted for the following conditions: hepatocellular carcinoma, cholangiocarcinoma, cystic fibrosis, hepatopulmonary syndrome, familial amyloid polyneuropathy, and certain other disease-specific conditions.
• Inactive status — Temporarily ineligible for a deceased-donor liver transplant.

How is your MELD score calculated?

Your MELD score is based on results from five blood tests that, together, show how well your body is functioning.

You will be tested for:

• Bilirubin — Shows how well your liver is clearing a substance called bile.
• Creatinine — Shows how well your kidneys are working.
• Internal normalized ratio (INR) — Shows whether your liver is making the proteins necessary for blood to clot.
• Serum sodium — Shows how well your body is regulating fluid balance.
• Albumin— Shows how well your liver makes albumin, a protein that carries substances like medicines, vitamins, and hormones through your blood. 

What does your MELD score mean?

The MELD score estimates your chances of surviving during the next three months. Organ allocation is determined by the Organ Procurement and Transplantation Network (OPTN). Livers from deceased donors are allocated to the sickest patients first.

What is the MELD score range?

The MELD score ranges from 6 to 40 and is based on results from several lab tests. The higher the number, the more likely you are to receive a liver from a deceased donor when an organ becomes available. The allocation system ensures that candidates with the highest MELD scores — between 30 and 40 — get a transplant first.

Updating Your MELD Score

Since your doctor calculates your MELD score, you're not responsible for updating it. It's up to your doctor to decide when you need new tests.

Make sure you attend all follow-up appointments, complete all necessary lab tests, and check in with your doctor anytime your condition worsens. You should call your transplant coordinator if you have questions about your MELD score.

How often is your MELD score updated?

Your MELD score changes as your condition changes. If you get sicker, your score goes up.

Depending on how critical your disease is, your MELD score may be recalculated as often as once a week.

Doctors look at your last MELD score to determine when to order new lab tests.

Here are typical MELD scores and how often they're recalculated:

• 25 or higher — Every week.
• 19 to 24 — Every 30 days.
• 11 to 18 — Every three months.
• 10 or less — Once a year.

Liver Transplant Waiting List — Additional Considerations

Your MELD score is a key indicator of how urgently you need a transplant. But, it isn't the only factor.

Other considerations include:

• Current availability of deceased-donor livers in your region.
• Geographical considerations — How close you are to the donor liver.
• Your blood type.
• Your body size relative to the donor’s.

Living-donor liver transplant for patients with a low MELD score

Patients with a MELD score under 15 are often not listed for a liver transplant because their likelihood of getting a liver through traditional allocation is very low. However, a living-donor liver transplant provides a lifesaving option and the chance to receive a transplant sooner. By considering a living donor transplant, patients with a low MELD score can still be eligible for a liver transplant.

Patients with a low MELD score should still be considered for a liver transplant, as many patients are sicker than their MELD score indicates. Living-donor liver transplants can be a lifesaving option for this group of patients who otherwise cannot receive a deceased donor liver transplant through the UNOS MELD score allocation.