Understanding MELD Scores

What They Are and Why They Matter

The MELD score plays an important role in determining who gets a liver transplant and when. It helps ensure that the sickest patients, those at the highest risk of death without a transplant, are prioritized.

MELD stands for Model for End-Stage Liver Disease and is a numerical scale used by doctors to measure how severe your chronic liver disease is. Doctors use a similar system called PELD (pediatric end-stage liver disease) for children under 12.

What exactly is a MELD score?

It is a score based on a math formula that uses the results from three standard blood tests.

• Bilirubin – measures how well the liver processes bile
• Creatinine – indicates kidney function, which is often affected in liver disease
• INR (International Normalized Ratio) – assesses how well the blood clots, a function tied to liver health

Using a mathematical formula, the score calculated typically ranges from 6 to 40. A higher MELD score indicates more severe liver dysfunction and a higher risk of death within three months without a transplant.

MELD-Na: A Refined Version

In recent years, the MELD-Na score has become more commonly used. It adds serum sodium into the calculation because low sodium levels are associated with worse outcomes in liver disease. This version improves the accuracy of survival predictions and helps better prioritize patients.

How MELD Scores Are Used

The MELD system was adopted by the United Network for Organ Sharing (UNOS) to help fairly allocate liver transplants in the United States. It replaced older, more subjective methods of determining urgency. 

Now, patients on the transplant waiting list are ranked largely by their MELD or MELD-Na scores. Those with the highest scores are considered first when a liver becomes available.

There are exceptions, though. Certain conditions—like liver cancer, hepatopulmonary syndrome, or recurrent cholangitis—may not result in a high MELD score despite serious health risks. 

In these cases, transplant centers can apply for exception points to elevate a patient’s score and better reflect their need.

What Patients Should Know

For people with liver disease, understanding your MELD score is important. It's updated regularly based on your lab results, and it can fluctuate depending on your condition. A rising MELD score might signal worsening health, while a lower score suggests relative stability.

Though it can be stressful to think of your health as a number, the MELD system is designed to bring fairness and objectivity to the transplant process. It ensures that limited donor organs are given to those who need them most urgently.

Staying Informed

The MELD score is more than just a number—it's a vital tool that guides life-saving decisions. It reflects how well your liver and kidneys are working, and it plays a key role in determining your place on the transplant waiting list. By staying informed and engaged with your healthcare team, you can better understand your MELD score and what it means for your treatment journey.