Policy

Fairness of MELD organ allocation system questioned

Last Updated: 2007-06-28 12:47:00 -0400 (Reuters Health)

By Karen M. Dente, MD

RIO DE JANEIRO (Reuters Health) - The fairness and utility of the current system for donor liver allocation, based on MELD classification, to all patients waiting for an organ came up for discussion at the 13th Annual International Congress for Liver Transplantation here last week.

MELD stands for model for end stage liver disease, and is a mathematical formula that gauges mortality risk in people with liver disease and has been used for allocating organ donations to recipients in the U.S. since 2001. Brazil has also followed suit and implemented this system a year ago.

"In liver transplantation it comes down to who gets the liver and who doesn't get the liver, and MELD has improved the transparency of the system," said Dr. Richard Freeman of Tufts-New England Medical Center, Boston.

There has been a recent trend toward higher MELD scores with more transplants being performed for patients with malignant disease over those with other forms of chronic liver disease -- with the latter generally having lower MELD scores and very low chances of ever receiving a liver.

"One of the criticisms of the MELD allocation system lies in the exceptions," said Dr. Freeman.

With exceptions -- and hepatocellular carcinoma is one such exception -- MELD scores are higher, and this influences all candidates, since it drives up the overall MELD scores and increases mortality rates among patients with lower scores.

"We need to find additional data to better develop risk scores for these patients and develop other end points; we suggested malnutrition, which may be arbitrary, but this is definitely the way to go," said Dr. Freeman.

"I think we are going to see a revision of the MELD scoring in the next few years in the U.S.," said Dr. Edson S. Franco, associate director of Liver & Gastrointestinal Pediatric Transplantation at Loma Linda University Medical Center, California.

"We need to be constantly vigilant of what happens here," said Dr. Freeman. He cautioned other countries not to blindly adopt the MELD scoring model as it is currently used in the U.S. without tailoring the details of the scoring model to the specific individual variations of their respective patient populations.