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New System Improves Distribution of Donated Livers
Date:11/25/2008

r of surgery at Tufts University School of Medicine, in Boston, and chairman of the committee that put the MELD system into place.

Also, the old system could be manipulated. For instance, patients in intensive care were given preferential status, so doctors sometimes put patients in the ICU to bump them up on the list. "Doctors were trying to do the best thing for their patient, but it was disadvantaging those who really did need a transplant," Freeman said.

The MELD score, which predicts the risk of dying within three months, is based on a formula incorporating three laboratory tests.

"MELD is based on pure blood tests, and it's hard to manipulate patients' blood tests," Freeman said. "The waiting time is taken out. It's based on who's sicker."

The authors of the new study looked at patients, black and white, on the Organ Procurement and Transplantation Network waiting list for liver transplantation between Jan. 1, 1996, and Dec. 31, 2000 (pre-MELD), and between Feb. 28, 2002, and March 31, 2006 (post-MELD).

Before MELD, 27 percent of black patients died or became too sick for a transplant within three years of registering for a liver, compared with 21.7 percent of whites. After MELD, that gap narrowed considerably with 26 percent of blacks dying or becoming too sick for a transplant, compared with 22 percent of whites.

And while blacks were less likely than whites to receive a new liver within three years of registering on the pre-MELD list, in the post-MELD era this is no longer the case.

Gender, however, is another story. Women are more likely to die or become too sick for a liver transplant under the post-MELD system. And they are -- and were -- less likely to receive a new liver within three years, regardless of the era.

This likely is the result of several factors, including women's smaller size (meaning they need a smaller liver), higher likelihood of having an autoimmune
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