I’ve already written a post about MELD score.  In it, we covered what it is, how it’s calculated, and what that means.  Yet, I still receive many questions about whether a person’s MELD is good or bad.

Your MELD Score Isn’t the Full Picture

When most people receive their MELD score (or calculate it on their own), they want an answer.  “If I am at a MELD 28, how long will I have to wait?”  Or, “My MELD is a 37 and someone I know was just transplanted at a MELD 25!  What gives?”

There are other people who look at their MELD score and want to know how it affects their survival rate.  And others want to know if they really need to have a transplant even though their score is low.

None of these questions have simple answers, but let’s address a couple of them as examples.

“I’m at a MELD 28, how long will I have to wait?”

There is no way to answer how long you will have to wait.  There are so many factors that go into matching for a transplant.  Nobody has a crystal ball.  Nobody can say, “Well, you’re at a MELD 28 and that means a donor liver match will happen in ‘x’ amount of time.”  In addition to that, your MELD score can change often.  That is why the higher your MELD, the more often you have blood draws.  As that number creeps up, UNOS is updated with your information for matching more often.  You may also be eligible for upgrades that affect your MELD, and those numbers change as well.

“My MELD is a 37 and someone I know was just transplanted at a MELD 25!  What gives?”

While the severity of your illness plays a huge role in matching, it’s not the only part.  It could be a matter of size, blood type, or location.  There could also be other medical factors playing into that match also.   It’s important to understand that it’s not a decision made by people.

Matches are made using a computer.  A “match run” is generated with recipients and transplant hospitals are notified.  Hospitals have a limited amount of time to view the donor information and either accept or reject a provisional match.  They also have a limited time to make contact with the potential recipient to accept the offer.  If the recipient can’t be reached, they are required to move to the next person on the list.

A Story About Matching

Back in 2008, there was massive flooding in Iowa.  There was a potential donor liver matched to a recipient there.  Because of the floods, it was impossible for the recipient to make it to the hospital.  The transplant hospital (local) had to decline the offer and the hospital for the next match was notified.  Because the next match was in the region (Colorado) the transplant happened there.  As you can see, it is impossible to predict how long a person will wait or what factors might come into play in matching.

What’s a Good MELD Score?

Generally speaking, the lower the score, the better.  For instance, a person with a healthy liver may have a MELD score of 6.  But that’s kind of an oxymoron.  Since MELD stands for Model for End-Stage Liver Disease, a person with a healthy liver wouldn’t need the score.  But, you get my point.

You can be listed with UNOS with a MELD of 15 or higher.  The thing to keep in mind is that the higher your MELD, the more likely you are to be matched with a deceased donor liver.  Many times, people who have lower MELD scores like this, will seek out a living donor.  The primary reason for this would be that people with higher MELD scores will receive priority with any deceased donor offers made.

What’s a Bad MELD Score?

Like lower generally means better, higher is worse.  UNOS recognizes MELD scores from 6-40.  While it is possible to receive a score higher than 40, it’s still the top number.  Hi there, I had a MELD of 45 at one point, remember?

There are survival rates based on MELD, but the important thing to remember is that it is only a number.  And while a higher number is worse, no number is a death sentence.

Good and Bad Are More Than Your MELD Score

Because we are all individuals, every person’s experience with liver disease will be different.  I have met several people who had a high MELD score (35-45) but were functioning well.  They were lucid, able to speak, and going about daily life relatively well.  I’ve met folks who had a MELD score in the mid-20s and were physically weak and unable to carry on a conversation.

Some people with a lower MELD were referred to physical rehab because they were not strong enough to survive transplant surgery.  Others had a high MELD and were walking laps around the halls of the hospital until their call came.

The point of all this is to say, that while your MELD score could technically be good or bad, it’s more than that.  The best thing you can do is do everything in your power to remain as physically strong as possible.  That way, when your call for transplant comes, you’re ready.

You Can’t Change Your MELD

Some people have suggested that if they could make their MELD higher they could be transplanted sooner.  Or, if they could lower it, they wouldn’t have to go through surgery.  Does your MELD score change?  Yes.  Is it something you can control?  No, not really.

Sitting on the sofa and decompensating won’t raise your MELD.  You may become weaker, but all that will do is decrease the chance of your survival after surgery.  In fact, it may cause you to become so weak that you are no longer a candidate for transplant.

There is no magic pill that will make your MELD score decrease.  Be wary of the claims for “liver cleanses” and natural remedies.  Fibrosis and cirrhosis are scarring to the tissue of the liver.  Permanent damage has already been done.  There is no herbal remedy or essential oil that will cure your liver disease.  On the contrary.  Taking a natural remedy could actually cause more damage to your liver.  Please talk to your transplant team before taking any vitamins, supplements, or herbal remedies.

Try Not to Focus On the Number

The best thing you can do is focus on your journey.  Listen to your doctors.  Try to get a little exercise.  Eat to fuel your body.  Talk to your therapist.  Thank your caregivers.  Enjoy each day the best you can.  Focus more on getting yourself to the finish line, and less on the number.  I’ve said it before.  This is a marathon, not a sprint.

Keep taking one step at a time and little by little you’ll be closer to transplant.