A MELD score that high would put you high on the transplant list in most places - depending on other factors of course
What does you medical team say?
Here is more information about the MELD score and liver transplant that you may find helpful. This is based on info from my transplant center here in California.
Who gets priority for a liver transplant?
Throughout the United States, patients waiting for liver transplants are prioritized based on the severity of their illness, as measured by what's called the Model for End-Stage Liver Disease (MELD) score. (Recipients are also chosen within each ABO blood group and also must be an acceptable body size.) The score uses blood tests to determine how urgently you need a liver transplant within the next three months. The sicker you are, the higher your MELD score; scores range from 6 (less ill) to 40 (critically ill). The sickest person in your region get the next compatible cadaver liver first.
Lab values used in the MELD calculation:
* Bilirubin, which measures how effectively the liver excretes bile.
* INR (formally known as the prothrombin time), measures the liver’s ability to make blood clotting factors.
* Creatinine, which measures kidney function. Impaired kidney function is often associated with severe liver disease.
People who need a transplant because of liver cancer obtain MELD points differently (not based on blood levels), based on time since being diagnosed with cancer because the longer you have cancer the more likely it will advance and could be fatal.
In the US there are many more people who need liver transplants than there are donors. Certain parts of the country have more people awaiting transplant than other parts of the country. This is especially true in California and the New York City area where there are long waiting lists. Because the waiting list is so long, you must have a very high MELD score (in the 30s) to get a transplant at these transplant centers. Most patients are quite sick by the time they receive a transplant, and some will die before they can get one. Some patients grow worse suddenly, and become too sick to receive a transplant. In other parts of the country people typically get transplanted with MELD scores in the 20s.
Is there a way to expedite a transplant?
Yes. One option is to go to a transplant center in an area of the country where the waiting list is shorter and patients get transplants with MELD scores that are much lower than what's needed in these regions with long waiting lists. If you're interested in this option, ask your insurance company for referrals to such centers or search the United Network for Organ Sharing (UNOS).
Another option is to receive a piece of liver from a living donor, called a living donor transplant. Living donor transplants carry risks for both the donor and the recipient, and not everyone is a candidate. If you'd like to know more about living donor transplants, ask your hepatologist or liver specialist, your surgeon or your transplant coordinator.
A third option is to take part in our High Risk Liver Transplantation Program. In this program, patients agree to be contacted when a liver that's considered "non-ideal" becomes available. Many transplants using non-ideal livers are successful, but these livers may carry a higher risk of not working well, or of transmitting an infection or cancer. We may offer you a non-ideal liver if we feel your risk of dying while waiting for a transplant is greater than the risk of receiving the non-ideal liver.
What's an "ideal liver"?
An ideal liver comes from a healthy young person who has died. Ideal livers are more likely to work well and less likely to transmit cancer or infection. In the United States, roughly a third of all liver transplants come from ideal donors. This means it's impossible for every patient to get an ideal liver.
It's important to note that it's possible to get an infection or cancer even from an ideal liver. The risk if low — probably less than one in 100 — but it's not zero. It's impossible to test donors for every type of infection or cancer, tests may not detect a problem and we may not know that the donor practiced behaviors, such as IV drug use, which would make the liver more risky. These are risks that every transplant recipient takes.
What's a non-ideal liver?
Many non-ideal livers will work fine and carry only a small risk of transmitting an infection or cancer, just like an ideal liver. Other non-ideal livers carry higher risks. If your medical team believes your risk of dying while waiting for a transplant is greater than the risk from a non-ideal liver, they may offer you the non-ideal liver.
Non-ideal livers from the following kinds of donors carry a higher risk of transmitting infection or cancer:
• A donor who was infected with hepatitis B.
• A donor who was infected with hepatitis C. We don't use livers from these donors unless the recipient already has hepatitis C of a particular kind, called genotype I, and only when the liver isn't scarred from the hepatitis infection.
• A donor who had cancer.
• A donor who was in prison, used IV drugs or had sex with a high-risk partner within the past year.
The following kinds of livers aren't more likely to transmit an infection or cancer, but they carry a higher risk of not working well:
• A split liver or a partial liver transplant.
• Livers from older donors.
• Livers donated after cardiac death. Most organ donation occurs after brain death, meaning the donor has been declared brain dead but all organs, including the heart, continue to work. When a liver's taken after the heart has stopped beating — called donation after cardiac death — there seem to be increased risks. The liver may not work as well, and the recipient may need an emergency second transplant. There also appears to be a higher rate of bile duct problems, meaning the recipient may need to have more procedures or the liver may not work well. And the risk of transplant failure appears to be 5 to 7 percent higher.
How do I decide between taking a non-ideal liver now and waiting for an ideal liver?
When a non-ideal liver becomes available the center will give you the best estimate of the actual increased risk from that liver. If you don't feel ready to take a higher risk at that time, you can decide to wait for another liver. Doing so will not affect your status on the waiting list. The risks and benefits of this decision may change over time if your liver gets sicker.
- I myself had signed up for most types of “non-ideal” livers as I waited for 4 years for my transplant hoping to get a liver as soon as I could while being listed at my transplant center that has one of the longest wait lists in the country. Over 700 people were and are waiting for a liver transplant at my center. Time was running out for me so I was willing to take any liver rather than die waiting. I ended up accepting and receiving a cardiac death liver and had no complications at all from that decision to accept a so-called "non-ideal" liver.
Also many of my friends had hepatitis C when they had their transplants and they accepted a liver infected with hepatitis C. There is no increased risk of taking a hepatitis C infected liver if you already have hep C and you can get a liver sooner that way. Now with the new hep C treatments most people can be cured before transplant so wouldn't have the option of a hep C infected liver.
Hector. What an interesting topic relating to liver donations. I've been told that I cannot be an organ donor since I have a past history of Cancer. It would seem valid that perhaps a less invasive part of my body could be used such as my cornea or retina for instance? I've always wanted to be a donor as so many lives could be saved, but unfortunately I'm denied.
May I ask, you mentioned that you took a non-ideal liver since your life was in the balance. Do they tell you the particulars regarding the gender, health history, and age of the donor? I would imagine that besides being grateful, you must somewhat of a connection.
Hope I'm not being to personal, but find the discussion fascinating.
I have had two different cancers and am an organ donor. It depends upon your history of cancer. Especially the cancer type and stage and when you last had detectable cancer. End of digression...
Yes, I had sign up for about all of "non-ideal" liver options.
I was told I probably won't survive a few months previously and had been fighting for my life every day that entire year. Finally after 4 years on the waiting list, kicked off and got back on at the last moment I got to be at the top of the list with a MELD score of 36, so I knew I was going to be offered the next available liver that was blood type O and compatible with my body size at my transplant center.
When you receive the call that a liver is available they tell you the sex and age of the donor and any known risk factors about that liver. You then say whether you want to accept it or not. Due to my critical situation I had already decided to accept any liver. Any liver transplant patient who is close to death will tell you they have thought of that moment dozens of times before it happens.
It turns out that my new 36 year old female liver is very compatible with my 62 year old body and I had no complications during the surgery or just after my transplant which is where the risk of a cardiac death liver typically occurs. I have been on every low levels of immunosuppression since my transplant my liver related blood levels are all within normal range and my body has not tried to reject my liver. So my transplant went as well as I reasonably could have expected and it certainly beats the alternative. I am grateful every day to my donor who has allowed me to open my eyes every day for the last 18 months since my life-saving transplant.
I have had and have other medical issues since my transplant but they don't appear to be related to my transplant surgery.
Thank you Hector for your reply.
I'm hoping your current medical situations are quickly resolved.
You are a wonderful spokesmen for all of us at Medhelp.