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Updates to medical urgency scoring of liver transplant candidates in effect

Published on: Monday, September 11, 2023

Effective July 13, 2023, improvements are in effect to OPTN policies regarding the medical urgency scores used to prioritize liver transplant candidates. The changes include:

  • Updates to calculation of the Model for End-stage Liver Disease (MELD) score, used for transplant candidates aged 12 and older, as well as the Pediatric End-stage Liver Disease (PELD) score, which applies to candidates younger than age 12.
  • Revised qualification criteria for pediatric liver candidates in either Status 1A or 1B. These two status codes, addressing rare and immediately life-threatening medical conditions, represent the highest level of medical urgency for liver allocation.
  • Updates to guidance for pediatric candidates for whom a medical exception score is requested through the National Liver Review Board.

The updated MELD score for adult candidates will increase parity in access to liver transplant between sexes. It also adds and updates diagnostic criteria within the formulas that will improve their ability to identify and prioritize the most urgent transplant candidates.

The MELD and PELD scores are both computed using objective medical tests or information known to affect a person’s short-term mortality risk without a liver transplant. The MELD now includes an adjustment for adult female candidates to make it easier for them to access transplantation. The updates also include the addition of an albumin variable to MELD and a creatinine variable to PELD. In addition, the coefficients used to calculate MELD and PELD have been updated to improve their ability to predict mortality risk.

The updates to criteria for children to be either a Status 1A or 1B candidate are intended to create clearer and more relevant standards, as well as improve the ranking of candidates within Status 1B based on their diagnosis and risk of mortality.

A resource toolkit is available on the Liver and Intestine resources page of the OPTN website. It includes frequently asked questions for clinicians as well as transplant patients and their caregivers, as well as links to webinars and other educational resources. In addition, the sample MELD and PELD calculators on the OPTN site have been updated to include the new calculations.