What is the Method of Ranking Liver Transplantation Patients?

Liver Transplantation

is a procedure in which a liver impaired by disease is replaced with a normally functioning liver from another individual. Today it is a well known treatment option for someone with end stage liver disease or for someone facing acute liver failure.
Most liver transplants come from deceased patients. However, sometimes living donors also donate parts of their liver. There is a huge list of people waiting to receive a liver. The demand outnumbers the supply at any point of time.

In the United States alone, around 17,000 people are in the wait list.

The most common reason for adults to undergo this procedure is Cirrhosis of Liver. In this disease, the healthy liver tissue is destroyed and is replaced with scar tissue. In children, the most common reason to undergo this procedure is Biliary Artesia, a disease which affects the bile ducts.
The liver is the second most transplanted organ after the kidneys.

Liver for Transplant

Criteria to qualify for Liver Transplantation

  • The United Network for Organ Sharing have laid down certain criteria to decide how to prioritize patients for the procedure depending on their condition. A Model for End Stage Liver Disease (MELD) scoring system has been devised to rank adults over 18 years of age in the list. Similarly, there is a model known as Pediatric End Stage Liver Disease (PELD) for children and teens below 18. Above and beyond the two models, the highest preference is given to Status 1 patients.
  • The highest priority is assigned to a Status 1 (Acute condition) patient. Typically such a patient would be diagnosed with liver failure and be needing intensive care treatment with less than 7 days of life expectancy.
  • The MELD score is arrived at by taking into account the laboratory values of creatinine, bilirubin and the International Normalized Ratio (INR). The latter is a measure of the blood clotting time of the individual. Besides the this scoring system focuses on those patients who do not have a life expectancy of more than 3 months in the event of not receiving the transplant. Depending on the patients score ( which could be between 6 and 40) the place of the patient in the waiting list is decided. If two patients have the same MELD score and blood type, then the one who has been longer on the list gets the life saving prize.
  • The PELD score just like the MELD score takes into account the similar laboratory indicators like Bilirubin, albumin and INR. In children the extent to which the disease is hampering the development of the child is also taken into account.

So first available liver would go to the status 1 patient and then onwards the MELD or PELD criteria would be used to rank individuals. However, there is a category of patients who do not qualify for

liver transplantation

. These would be patients with a history of alcohol abuse, severe heart failure, cancer, severe liver failure coupled with brain damage and HIV infection.

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