Waiting for a Liver Transplant: My MELD Score is Low-Now What?

Liver Transplant Surgery

Model for end-stage liver disease, also known as the MELD score, is the most commonly discussed topic when meeting with our liver transplant waiting list patients. Discussing the MELD score is the most anxiety provoking part of any conversation that we have with our patients. The reason it raises such anxiety is because the decision on who is allocated a donor organ is based on an individuals MELD score. Those with high scores receive a new liver, while those with lower scores continue to sit and wait on this guidelines. While no system is perfect on how to allocated donor livers, the MELD score works out for the majority of patients. What I’d like to discuss here is what happens to patients that have a low MELD score, and how they deal with the waiting time, as well as the emotions associated with it.

Without going into the complex calculations in determining how the MELD score is calculated, simply realize that sicker patients, for most part, have a higher score. As we have discussed in other entries, the MELD score is calculated the patient’s creatinine, bilirubin, INR. These are all laboratory tests that are routinely obtained in our patients with cirrhosis. It has been previously determined that the higher the MELD score, the lower the survival is. Based on this fact, it has been agreed that those patients with the lowest survival rates receive donor livers first. Generally speaking, the MELD score will range between values of 5 through 40. Based on prior research, a MELD score of 40 or greater is associated with a 71% 3 month mortality. In simple terms, this means that there is a 71% chance that an individual will not survive the next 3 months. Similarly, a MELD score between 30-39 as a mortality of 53%, and scores between 20 and 29 have a 20% three-month mortality. Of interest, MELD scores of 15 or less have improved survival and only a 2-6% chance of dying. Many liver transplant programs, based on these survival statistics, preferred not to place patients on the active liver waiting list until there MELD score is 15 or greater. There is some research that suggests transplanting patients with very low MELD score is is associated with a worse outcome, and survival. As we say many times with our patients, being a little sick with cirrhosis and liver disease may not be enough to get you a transplant, but being too sick, with MELD scores greater than 40, may put you in the position where you are too sick to survive with good outcomes.

There is no doubt that we take care of many patients that have a low MELD score, associated with a statistically ok survival, yet they are plagued by numerous incapacitating symptoms. Many of these patients are unable to work, participate in usual family activities, and are constantly visiting their are numerous physicians, having frequent hospital admissions. There is a subset of patients that fall into this category, creating a very frustrating situation for both the patient and their family, as well as for the the physicians, nurses, and surgeons. As I mentioned at the beginning of this entry, this is a great source of anxiety, and regular topic of conversation. Patient’s have a difficult time understanding how they can be so sick, yet they are low on the organ allocations list. Despite their disabilities and frequent hospitalizations, they are very far from receiving a liver transplant. So, what are they to do?

The discussion I have with patients regarding this is usually well received. Unfortunately, there are patients that are frustrated with the system and feel as if they are somehow being discriminated against because of their low MELD score. Time and time again, we explain to the patient and their family how the scoring system works, and the rationale behind. Nobody ever wants to here that there is someone worse off then them, but  that this is the very nature the system.

Patients that have a low MELD score need to remain fully engaged with the their health care. They need to remain as physically active as possible, so that they’re able to maintain their strength and physical conditioning. Walking, light exercises with weights, swimming, and general physical activity around their house is key. The important point is that this is done on a regular basis, which ideally would be at least 5 days per week. Excessive sleeping, sitting, and general lack of activity will ultimately have a negative impact on both their current status, as well as how they bounced back after successful liver transplant surgery.

In addition to physical activity, maintaining a healthy diet is equally important. For most of our patients with cirrhosis, portal hypertension, and chronic liver disease, they need to maintain a low salt diet. We generally recommend a diet that contains less than 2000 mg of sodium per day. In some cases, we would like this to be 1500 mg of sodium per day. To maintain such a strict diet, you need to consume fresh fruits and vegetables, and fresh lean meat or fish. I tell all my patients that they need to avoid any foods that come from a box, can, or bag. Eating out, even in what appears to be a high-quality restaurant, we’ll only serve you food that is overly salted, high in fat, and high in calories. There is almost no way that you can maintain a low salt diet to this degree by eating out. Excessive salt in the diet will lead to fluid retention which is a major reason for both physician visits, as well as repeat hospitalizations.

In addition to physical activity and nutrition, patients with a low MELD score need to remain compliance with all of there medications. If you were having any side effects from the medicine, speak with your physician and liver transplant team. Likewise, discontinue medications on your own will lead to problems.  Resuming the medications that previously were discontinued, can also lead to problems.

Patients that have a low MELD score need to remain optimistic and not lose hope. This system is not perfect, but generally works in most situations. The reality is that we do not have enough donated organs to share, and this is what leads to problems. Nationally, 30% of patients waiting for a liver transplant do not survive. Patient’s come to our liver transplant programs very late in their disease, when we have very little opportunity to change their course. Patient’s that are referred early, generally will have better outcomes, but at the same time, we will be caring for a lot of low MELD score patients. MELD scores are recalculated every time blood work is obtained, updating there status within the UNOS database. Based on the 3 parameters that are entered into the computer, complications such as infections or bleeding will results in the increase of the MELD score. While no one like to see these complications, which can be life-threatening, they do results higher MELD scores.

71 Responses to “Waiting for a Liver Transplant: My MELD Score is Low-Now What?”

  1. Ray Gilbert 06/16/2012 at 10:37 pm #

    Excellent remarks.

  2. Leslie Zimmerman 09/09/2012 at 4:10 pm #

    I can’t see telling someone who is limited in how much he can do by the extremes of complications should “remain fully engaged”. If the physical limitations put on someone because of an illness (in this case autoimmune hepatitis) restrict LIFE, how does this NOT contribute to the determination of who gets a liver and who doesn’t. The numbers work for the majority of cases, but what about the cases where the numbers should not be the ONLY CRITERIA for who gets an organ.

    • Dr. Joe Galati 09/09/2012 at 10:16 pm #

      This is a key point. The MELD score works for the majority of patients, but it is far from perfect. In certain situations, there are “MELD exceptions”, allowing programs to add points to the score, increasing the true “biologic” score. This is very frustrating to patients and physicians, in that the MELD score does not always reflect the degree of illness, and thus the need for transplant.

      • Leslie Zimmerman 09/10/2012 at 10:14 am #

        How are these “meld exceptions” determined, and who determines them?

      • Laura Barnes 04/23/2013 at 6:55 pm #

        My 41 year old son has PSC…Primary Schlerosing Cholangitis….he works in Los Angeles and has been a patient at USC Medical Center. His hepatologist and gastroenterologist have done numerous ERCPs and inserted stents. His bilirubin is at a 6 and his MELD score is low….but he is itching terribly, jaundiced, fatigued and generally weak. He is insured through his employer, who is self insured. He was turned down by the transplant team there . His bile ducts look like tangled tree branches and yet the MRCP shows no blockage. His doctors are saying he is going to have to get on a transplant list, and to do so in another area such as Texas where we moved to from Long Island, New York.

        This is such a complicated situation due to the insurance aspects of it, but we want to help save his life. What is the best area to be in with the greatest possibility of him getting the treatment or transplant he may need? And do you have suggestions how we start this process? He is in the hospital right now. He got pancreatitis last week after they inserted the stents.

        Thank you so much for any help or information you might have.

        • John Weiman 09/26/2013 at 10:04 am #


          I have a Meld Score of 9 and I am on the list. Your son HAS to go to a state where the wait list is low. California and New York has the highest numbers in the country on their wait list. For example, the musician Lou Reed left New York to go to Cleveland because the wait time was much lower. Keep in mind it’s statically proven that transplant centers who do more transplants have better results. So look for a state like Ohio (Cleveland Clinic) that has a great hospital. This is why Apple CEO had his done in Tennessee. He got his transplant at 15. You must check to see if his insurance will allow this. BTW, My “back up center ” is in Alabama as I live in Maryland. Feel free to contact me at Johnweiman@earthlink.net

      • Jerry Cenquigrana 07/11/2013 at 12:20 am #

        I just found out today that my MELD score is at 6 after starting out at 26. What can I expect since that appears to be within normal range and all blood work is within optimal ranges also. However, I still have grade 1 esophagus varices and portal hypertensive gastropathy. My duodenum is normal. Now, I quit taking my medications three weeks ago because one or two of them were making me sick, I just don’t know which ones and I have felt much better being off of them with more energy and I no longer spend the day wanting to just go back to sleep. Other than the varices and the chance of developing a mass on the damaged liver, do I have anything else to worry about. Now keep in mind I have not seen the results of the abdominal MRI, and on a side note I will continue on my propranolol that I take for my blood pressure which will also help with the varices. I’ve never been on a list and I don’t drink (2 years). What can/should I expect?

        • Jerry Cenquigrana 07/11/2013 at 12:24 am #

          One thing I forgot to mention. My doctor has put me on a three year re-evaluate for the varices. I have not received a schedule for the MRI yet.

        • Dr. Joe Galati 07/24/2013 at 8:26 pm #

          With a low MELD, the short term prognosis is good. Regarding the meds, talk with your doctor regarding possible substitutions; understand what they are for as well. As mentioned, developing liver cancer (hepatoma) is always a concern in liver cirrhosis. Screening is usually every six months with a scan and blood work.

        • Alice Lee 07/30/2013 at 4:14 am #

          Congratulations that yr meld score has dropped from 26 to 6. My husband was dignosed with liver cirrohsis in March 2013 and his meld score is 15. Just wanted to know how does yr meld score dropped so much which I heard from the doctor before that not possible that meld score will drop.

          Thank you and hoped to hear from you.

          Stay healthy!

          • Jerry Cenquigrana 11/05/2013 at 9:26 pm #

            I forgot all about this post, sorry. All I can say is that because I had quit drinking, what is left of my liver is performing adequately. I had told my doctor that I didn’t have a drinking problem and for me to stay away from beer was no problem, and it hasn’t. This leaves me wondering, if you have a big enough blood clot at the portal vein, so much so that it cut off enough blood flow, could this account for the damaged liver, could if of caused the problems with my other organs? I just don’t know. It’s been 2 years and 7 months, although I went off my medications for a few months, I had to go back on them. My feet started swelling, and it was hard to concentrate and since I am going to college, I didn’t need that. I still have an occasional dizzy spell so I try not to drive too much, long trip with me driving are definitely not on my list. My last MRI showed my cirrhosis is still there but there was no sign of cancer growth. Alice has your husband been back for a checkup since you last posted? Feel free to contact me at jcenquigrana@npgcable.com

      • Thomas Meyers 08/09/2015 at 5:18 pm #

        Hello Dr. Galati,

        My older sister (69) has a meld score fluctuating between 10 and 18. Cleveland Clinic has not (as of now) agreed to putting her on the list. She has a variety of complications from varices that need to be banded to fluid build up in her abdomen requiring peritinisis on a weekly basis sometimes sooner, removing 3 to 6 liters of fluid each time. She has just been hospitalized because of an infection.

        My question has to do with a living donor. She has a living donor that matches, (her 34 year old son).

        Since she has a living donor, does the meld score even have to be considered in this type of situation?

        Your input will be much appreciated.

        • Dr. Joe Galati 08/21/2015 at 10:51 am #

          Generally speaking, with a living donor, MELD score, per se, does not come into consideration.

    • Evangelina Wilson 02/02/2015 at 12:40 am #

      I completely agree with you. My husband failing liver will not permit him to engage in exercise. He is deteriorating and his meld score will not go up. They call it a meld score trap.

  3. Mary Leonard 10/10/2012 at 3:47 pm #

    Very informative. How does one get on the liver transplantation list? Is 70 yrs. of age a definate cut off time. Since I am 69, working part-time 20-40 hours a week, enjoying life with husband, children, grand and great-grand children, but with asities and ankle swelling (taking
    diuretics for these and also taking Urso ), stil cooking and cleaning, but really beginning to feel tired, should I seek the liver transplation list.

    • Dr. Joe Galati 10/13/2012 at 9:48 pm #

      Well, if you are doing very well, you may not need a liver transplant. Yes, the older you get, the more likely problems may arise. Look at prior blogs regarding MELD score calculation, and see what your score is. If it is under 10, you’re probably OK; 10-15, you need very close follow-up. Greater than 15 and transplant should be discussed. This is always a conversation to have with the team that knows you best.

  4. Apryl 01/13/2013 at 9:03 am #

    So glad I found this forum. Got some questions. First though short history on situation. I have a uncle whose 50 yrs old, has been diagnosed with Hep C and cirrhosis for about 2 yrs now. He owns a small carlot and waited to long to get ins. He has been accepted for a 6 mth trial where he can get help but it runs out in April. He just went to his first appt at UAB, and met with the Drs. They took alot of blood and said his MELD was 12, and the Dr didn’t see anything that would keep him coming back until next yr. His next appt is Jan 2014, and has applied for numerous ins and has been declined. Do you know of any help I can get. I want to get this ball rolling. Dr said he needed to be on meds, but he can not afford them. Any help there? Last, I heard immediate family could be living donors, is this true and how can I find out if I qualify. Thank you, anxious for a response.

    • Dr. Joe Galati 01/13/2013 at 3:28 pm #

      The insurance issue is a problem. I’d check with social services to see if he qualifies for any coverage. This would be a state run, or country run program.

      Regarding the hepatitis C, there are research programs that are targeted for HCV with early cirrhosis. A MELD of 12 is borderline for “early”. Unfortunately, the HCV therapies can precipitate a worsening of liver function, so one has to move with great caution. Someone with cirrhosis needs to be seen at least every 4-6 months, screening for liver cancer (aka hepatocellular carcinoma) with lab work (alpha-fetoprotein) and a scan of the liver (ultrasound, CT scan, MRI). A year is just a bit too long to wait.

      Good luck.

      Dr. Joe Galati

  5. Apryl 01/16/2013 at 12:24 am #

    Me again. My uncle is applying for sone preexisting ins through the state of Ala. After alot of research, I am still unable to find anything on a trial to sign up for. His grade is 2 and his score is 4. I want to see another Dr. Do you guys think you could help him. Please please. I dont know what to do, just want him to stick around a little longer. Hate to bother you. Thanks so much, God BLess.

  6. Ethan 02/23/2013 at 8:35 am #

    My father has been stuck in limbo with a MELD hovering between 14 and 16. He had fallen and fractured his femur back at the end of 2011, his MELD score spiked after that presumably from the additional stress that accident and hospital born infections put on his liver, but after he recovered (over a year) from that injury, his MELD has settled back down from a high of 19 down to 14. His attitude is terrific and he’s 100% compliant with diet and meds, but his quality of life is terribly low. The fact is he retains so much water that he cannot be vertical for longer than an hour without his feet swelling up like balloons, and if you walk around on those for too long, there is a good possibility of popping a foot balloon inviting infection, and then he’s screwed for another reason. So I have a hard time telling him he needs to go out for a jog. The MELD system has absolutely failed to capture my father’s quality of life, and is making a judgement about risk and reward associated with surgery. If *HE* would rather leave this world than hopping in and out of bed managing which part of his body is filled with H20 due to gravity…. And this doesn’t even begin to address night time confusion, disruption to sleep cycles, and encephalopathy in the evenings which has necessitated a full time care taker for the last year (Serious $$ out of pocket or you could say goodbye to the sanity of other family members trying to take on the care responsibility). I understand the western medical system’s desire to “do no harm”, and I understand the principal’s of supply and demand that are married to “do no harm” in such a way that livers are given to those that simply have the greatest chance of death if not transplanted. But the result of these high level policies is that *harm* is being done – prolonging the timeline in which my father and those around him suffer in a situation where my father is forced to live with extremely low quality of life, where he can walk for an hour and then put his feet above his belly to let that fluid go back to the reservoir. From my intimately close proximity to my fathers medical condition, I’ve concluded that the MELD score and a hospitals willingness to list and transplant needs to take into account the patient’s personal willingness to risk death or other complications from surgery as compared to current quality of life, otherwise the system is failing its core principal and is doing harm.

  7. Erich 03/15/2013 at 7:17 pm #

    I have had a MELD at 15 or so for a couple years now. I just did a new test and my bilirubin dropped dramatically to where my MELD calculated at 9. I have not been on any retrovirals but am also co-infected HIV. Is it unusual that the bilirubin could drop that much in a 6 week period? I did eat a full meal prior, should the test be administered while fasting?

  8. kieran gillingham 04/10/2013 at 7:44 pm #

    my meld is 7 I am a acholic candidate but am cutting down to nothing with hep c geno type 1a are you saying the cure for hep c can be worse for my liver

    • xbronx 02/14/2015 at 3:31 pm #

      There are new drugs for HEP c. Harvoni being the big dog. Problem is it cost 80000. For for folks who cannot afford it..

    • Jim Collins 04/09/2016 at 7:52 pm #

      Harvoni, without ribavarin, is truly a vast improvement for Hep C treatment. The biggest problem I encountered was interferon. Interferon is not used with Harvoni. I wish Harvoni was available 22years ago whenI was first diagnosed . Good luck with your treatment Don’t fail to reach out to the manufacturer if insurance becomes problematic. Better yet, have your Doctor to reach out to them. Harvoni was the fourth regimen for me. Don’t hesitate

  9. john 05/13/2013 at 12:46 am #

    Let me first say, I’ve been listed for transplant for two years… Diagnosed 5 years ago. Through paracentesis, I’ve had over 3,000 lbs of fluid taken from me and two TIPS revisions. I’m well aware of the MELD score controversy and there are very few exceptions. My experience has been the patient accepts the realities of the MELD score. Family and loved ones do not. They mean well, but it leads the patients to feel “they don’t understand” My brother actually thought I would move up the list because I’ve been 100% compliant. It doesnt work that way. If you want a short cut, consider “extended criteria” donors. Also, keep in mind, once you are listed, the hospital will be evaluated by UNOS for their success rate. It is in the hospital’s best interest to keep ALL patients alive. A lower than normal hospital success rate can affect their eligibilty to perform transplants which lowers hospital revenue. Regardless, Doctors will always do what’s in the best interest of the patient which will give them the best chance for survival!!

  10. manny 05/23/2013 at 2:17 pm #

    well I do understand that the meld scores real objective is to give a liver not too he bravest of people out to be willing to risk it all . but to use a real liver to the best canidates worthy of the gift. lots of brave sick people out there but very few livers to go round. I know I am one of those people willing to try any thing to get a liver but has been turned down by the meld score.

  11. Dustin 06/10/2013 at 10:53 am #

    I was diagnosed with a blockage in my portal vein at the age of 15 which along with continual internal bleeding (and possibly other factors, not including drinking) has led to cirrhosis for a period of over 20 years (now in my forties). One thing I believe that needs more attention is focusing more energy on awareness to increase the donor pool to help balance supply and demand. This would then allow patients with a low score, but low quality of life to have greater access to a transplant. FYI, my score is 12 which I found out today for the first time although I have been diagnosed with cirrhosis for a long time. Very interesting that after decades of follow up in the us (highly ranked HMO’s) with a diagnosis of cirrhosis that I have never been prescribed a regular check up (except for annual check of anemia/bleeding via hemoglobin check), although a low sodium diet was recommended. I have been on an international assignment in Brazil for almost 2 years and now have been recommended for the right steps missing back in the US (check liver and renal function every 3-4 months, ultrasound of liver every 6 months, medicine for portal hypertension due to blockage in portal vein, etc.). I am very thankful for the treatment, but also pray that we can increase awareness of the need to donate leading to an increased donor pool to help those in need (I do not need one now, but was moved by the stories above).

    • Jerry Cenquigrana 11/05/2013 at 9:42 pm #

      I find your story intriguing. Did your doctor tell you that your cirrhosis was caused by the blood clot? If you read my stories above, you will see why I ask. My doctor told me mine was from drinking, although I mostly drank light beer, and very seldom would I drink hard liquor plus I quit drinking with no problem so it’s not like I was addicted to it. My liver wasn’t the only thing that suffered when I got sick. My pancreas, spline, and kidneys suffered also so that is what got me thinking about the blood clot. Could I have been misdiagnosed?

  12. Kyle Simonson 06/24/2013 at 12:39 am #

    What about someone with a low meld score but suffering from varices (one major bleeding incident), every three months EDG reveals more that have to be banded, anywhere from 3 to 7. I had a portal vein pressure test, and the doctor said it was the highest he had ever seen in 20 years of of performing the procedure. I believe they used the most common method, block and measure. They have me on 80 mg of nadolol, and I still have varices every three months.

    Is this at all calculated in?

    • Dr. Joe Galati 07/24/2013 at 8:31 pm #

      Unfortunately, this is not taken into consideration. If bleeding was uncontrolled, an exception could be submitted. For now it seems you need to follow-up closely.

  13. Scott 06/30/2013 at 12:09 am #

    What are your thoughts on a RAPIDLY increasing MELD Calculation? I was a 15 in May. Monday 6/24 I had follow-up with my GI/Hepatologist. At that time, values increased to 7.4 Bili/1.2 INR/1.14 Creatinine. This increased MELD to 17.

    Thursday 6/27 IR conducted a 6-month ultrasound on 2nd TIPS (1st failed after 72 hrs). Portal flow is good, pressure is within range, etc. However, another lab was drawn. Values were 9.3 Bili/1.27INR/1.17 Creatinine. MELD is now a 19-20. (DOB 4/21/1976)

    In 5 weeks, that is a 4-5 point increase (I wasn’t positive where to round at and it works out fractionally based upon most current labs. My concern is that 2-3 point gain in 72 hours. I walk 6 miles daily, so my tan hides a lot of external symptoms, such as jaundice, except my eyes, but they yellow at 5+Bili.

    Points of reference/phys characteristics:
    37yo male, 6’1, 215lbs, physically active
    Diagnoses: Portal Hypertension, Autoimmune Hep, Cirrhosis w/no mention of alcohol.

    Current meds: Aldactone, Lasix, Lactulose, Folic Acid, Zinc Sulfate, Calcium, Prilosec

    Any advice while I wait for transplantation would be appreciated.

    • Dr. Joe Galati 07/24/2013 at 8:28 pm #

      The MELD score can change, based on changes in clinical status. A rapid rise is always a concern. We would be concerned for the development of an infection, tumor, portal vein thrombosis (check the TIPSS), or possibly a drug interaction. See what your team thinks.

      • Jerry Cenquigrana 11/08/2013 at 2:22 am #

        Is it possible that my cirrhosis was caused by a blood clot? If you read my stories above, you will see why I ask. My doctor told me mine was from drinking, although I mostly drank light beer, and very seldom would I drink hard liquor plus I quit drinking with no problem so it’s not like I was addicted to it. My liver wasn’t the only thing that suffered when I got sick. My pancreas, spline, and kidneys suffered also so that is what got me thinking about the blood clot. Could I have been misdiagnosed? I have another question because I am a little confused (No not Dementia). Why can they take a portion of a healthy liver and transplant it, and your fine. However, why can you not removed the damaged portion of the liver and let it heal as you would by replacing it? Wouldn’t it make sense to remove the damaged portion and eliminate or reduce the chance of developing cancer? Feel free to email me directly if you can answer my question.

  14. Shannon 07/13/2013 at 9:12 pm #

    Hi Dr. Galati,

    So we just found out that my dad is in the extreme scenario with a MELD of 39. He is in denial that the situation is this bad and refuses to stop drinking. We can’t put him on a transplant list until he has been sober for over 6 months and I do not even think he has that long to live. He has become irrational and almost unaware of his surroundings. His moods have changed and sometimes he has this glass look where he looks right through you when you are speaking. He doesn’t remember things and he sometimes doesn’t realize you are there. His health has been declining for some time now, but like I said, he refuses to acknowledge how sick he is. Being that I am the executor of his will, do I have the right to ask the doctor to say he is unfit and should be put into a nursing home or take his license away?! Thanks so much…

    • Dr. Joe Galati 07/24/2013 at 8:23 pm #

      Sorry to hear about this. I would talk with his physician and get a clear picture on his prognosis and likelihood of this reversing. The 6 month rule is generally enforced, but there are exceptions, on a case by case basis. What center is he at?

      • dee 02/23/2015 at 10:02 am #

        What are the cases that will allow you not to wait the 6 months ?
        My husband was at 36 and he is now at 19.

  15. Mickie 07/26/2013 at 5:35 pm #

    Hi Dr. Galati,

    I just received my husband’s new blood work but the bilirubin numbers vary from the hepatic function panel (1.9 total), general chemistry (2.6 total), and comprehensive metabolic panel (5.2 total). The creatinine also varies. Which test should I use to calculate the MELD? Also, he’s not on dialysis and his INR is 2.2.

    Thanks for any help you can provide!

  16. john Wilson 10/18/2013 at 8:58 pm #

    I have been caring for an old friend of mine since May 1st of this year. He had lost his home and was diagnosed with cirrhosis. At that time his MELD SCORE was a 33. I took him into my home, took care of his diet, meds, doctor visits etc. At one point he had an ICH which may or may not have been caused by a bump on his head. He was hospitalized for 22 days using all sorts of exotic blood recombinants, transfusions etc. to get the brain bleed under control. It will be 6 months next week since he quit drinking alcohol and he has vastly improved. His latest MELD score was a 13. Is it unusual for a score to improve that much in 5 months? Can it go lower? Does it indicate improved liver function?

    • Dr. Joe Galati 10/26/2013 at 3:34 pm #

      Yes, the MELD score can vary, based on the function of the liver. With improvement, the score can decrease significantly.

  17. Jerry Cenquigrana 11/05/2013 at 9:56 pm #

    Dr. Galati,
    I completely understand the issue with the MELD scores. My doctor had told me over two years ago that he wanted me to go through outpatient treatment for alcohol, he said he couldn’t put me on the list until I did. As I said, that was over two years ago and I haven’t had one sip of any form of alcohol and as I mentioned my MELD score at my last check was at 6. With that said and all things considering, I don’t believe I will ever end up on a list unless the other half of my liver fails or develops cancerous growths. Now I would really be happy if I could get off my medications, they really seem to drag me down as far as energy and motivation. But then again, if I were to get a transplant, I understand I would be required to take anti-rejection medications for the rest of my life. Is this true? jcenquigrana@npgcable.com

  18. Don 12/02/2013 at 12:01 pm #

    The practice of splitting of livers into two pieces is a documented success. The people who control Livers being kept as 1 piece, need to realize if 6000 livers are available with splitting thats 12000. people need to contact their elected officals and demand they make the community modernize and go to the split Liver transplant. doubling the amount available for transplant that equals how many more Lives saved,and isnt that what medicine is supposed to be about. Lives saved not outdated policy and money made.

  19. K Beecher 12/10/2013 at 9:35 am #

    Hello. My husband was 24 to 48 hours away from dying in an ER five and a half years ago. Even though he had stopped drinking more than six months before, I had to fight with the doctor who released him from the hospital to refer him to the transplant clinic. I am very happy that I did. Today we found out that his MELD score is now a 6. The clinic (at Yale) said that they had never had anyone go back down to a 6. It had been at 15.

    We believe it was sheer will to survive. He only needed the low sodium diet for about six months and was only on the medication for the same amount of time. He exercises five days a week and is healthier than he has ever been. He decided that we needed him and that it wasn’t his time. I am an energy healer and do Reiki and other energy treatments on him almost every week. We know that has helped as well.

    His doctors originally said that there was no way that the damage would reverse itself and that he would need a transplant within three to five years or he would die. He did everything they said and goes to every appointment including the MRI’s every six months for cancer prevention.
    I even try to get him to eat super healthy like me and he still eats what he wants, even without a gall bladder.

    He is living proof that with the right attitude and determination you can do anything. Try every alternative treatment as well. There IS hope. Don’t give up.

  20. xbronx 02/14/2015 at 3:28 pm #

    I have a MELD score of 7. I have ONE 2+cm cancer spot on my liver. TACE is my next stop. I exercise everyday. Feel fantastic! No symptoms of anything.

  21. J. Pate 02/25/2015 at 10:18 pm #

    My nephew’s meld score is at 30 and he is really suffering. My family and I are praying because he truly needs a liver now. The transplant team seem to see no urgency. It is hard to watch. For the first time in my life I feel helpless. I am praying for a miracle. He is a school teacher, born with a liver condition, which developed into liver disease. He was in graduate school trying to obtain his master in education. He is on the liver transplant list but the meld score have to be higher to receive a transplant. I am praying that God would please grant this miracle for him. This is the saddest thing I have ever seem. GOD PLEASE HEAR MY PRAYERS, IN JESUS NAME! Amen

    I need to know what to do before it is too late! Praying for all of you and for your healing!

  22. J Porter 03/31/2015 at 12:18 pm #

    I have a questions I was dx with NASH and told that I have now have stage 4 cirrohsis of the liver. My meld score is 10.2 I do not know where or when to become concerned I have 3 family members that are willing to donate a portion of thier liver to me if they are a match. Right now I feel great, but I was told that I would eventually need a liver transplant? My question is since my MELD score is low, do I have to wait to get sicker to get better? If I have a live donor does that make a difference in when I would be able to have this taken care of? I pray for all that are sick.

    • Dr. Joe Galati 04/17/2015 at 11:25 pm #

      Yes, the MELD score has to increase to get transplanted-based on your location. IF you had a living donor, and evaluated at a center that does them, it can be done much sooner.

      • J Porter 04/20/2015 at 6:47 am #

        Thank you Dr. Galati, I do have a consultation in June at the KU Medical Center in Kansas City.

  23. manzarm 04/10/2015 at 6:36 am #

    Thanks a lot to share such an amazing information.

  24. T. Lee 08/18/2015 at 6:56 am #

    Dr. Joe Galati thank you for taking time to answer so many questions, I’m a 58 year old male, diagnosed with Alcoholic cirrhosis of the liver in 2010, it took 2 years of hard work and many tests before I was considered by the transplant team to be placed on the list, I live in California, one of the absolute worst places to be needing a liver transplant, fortunately i’m a US Army Veteran and receive my medical treatment from the VA, I know all the problems in the news about how bad the VA healthcare System is but I must say I have never seen any of that, my experience with the VA has been outstanding. Being in the VA system puts me in a great situation in that our nearest transplant center is Portland Oregon, that takes me out of the overloaded California system. My MELD score several years ago was 24 but it has been dropping and now is 10, my health has been manageable, I have very little stamina and I feel tired most of the time, keeping my ammonia level down is a struggle, I do understand that the longer I can manage with my own liver the better off I will be, my concern is can I be removed from the transplant list if my MELD score keeps dropping? I would hate to start that whole process over again when I start to have more problems.

    • Dr. Joe Galati 08/21/2015 at 10:49 am #

      If your MELD score improves enough, it will be an indication that your liver has healed…not to say you’re cured of your cirrhosis, but enough that your survival will be better without a transplant. The HE may remain an issue. The best plan is to remain listed for transplant, and be sure you are screened regular for liver cancer. Good luck.

  25. Azg 09/02/2015 at 1:18 pm #

    How does one start the documented proof of sobriety of 6 months? AA is anonymous so do transplant centers required in patient care? I have no desire to drink but my word that I don’t or haven’t after many years probably doesn’t count. I

  26. Azg 09/02/2015 at 4:41 pm #

    I tried to post earlier. I was wondering if transplant centers even transplant for patients who have corrohsis due to alcohol like myself. I have stopped but the damage is done. What do they use to document sobriety if by the Grace of God they even entertained evaluating people like me?

    • Dr. Joe Galati 09/08/2015 at 9:00 pm #

      There are several methods to document sobriety. Breath testing, blood, urine. It’s not just one single method. We are fortunate that we have developed an entire process around patients with alcoholic liver disease to have the best outcomes.

  27. Toni 09/23/2015 at 12:35 am #

    My 65 year old mother has NASH. Her meld score seems to drift from 12-19 and she is having trouble getting on the transplant list at Cleveland Clinic. Over the course of the last year, when her meld score was still around 12, she started losing her ability to care for herself. Almost seemed like burr logical problems. Now she can no longer walk, feed herself, bathe herself or use the bathroom herself. Doctors can not seem to explain why her condition has worsened 10 fold in the course of a year, but her meld score only rose mildly. More recently, she is hospitalized (admitted) about once a week for high ammonia and uti infections, then then released after a few days…. Only to have to return 48 hours later. She has even slipped into a coma for about 4 days. For this in July. Cleveland clinic transported her from our small town 3 hours away. Once they controlled the infection, they released her and told her to keep her appointment 2 months away. Now her belly is filling and needing drained every 2-3 days. Is this all normal? I’m afraid she is going to die waiting to be tested just to get on the list.

    • Dr. Joe Galati 11/15/2015 at 12:27 am #

      She needs to be evaluated for transplant based on the above statements.

      You may need to seek out another opinion.

  28. Michelle 09/28/2015 at 8:05 pm #

    I am a 54 year old women that has been snuggling with GI issues for the past year, I have had upper and lower GI testing and was told it was stress. Since I have had blood work showing Bilirubin 2.6 mg, AST 166 ,ALT 42 and Platelets 95 and Creatinine Serum of ,48.
    I am feeling much better but this blood works concerns me. Would this mean I have a MELD level of 61?
    What should my next step be?

    • Dr. Joe Galati 11/15/2015 at 12:26 am #

      These issues need close evaluation. You should see a liver specialist.

  29. Jane 10/24/2015 at 2:28 pm #

    Is there a website anywhere that tells in black and white what the average MELD score is to be considered for a liver transplant in each region? I am in a region with a high MELD score for consideration.

  30. Kim 11/19/2015 at 9:55 am #

    My aunt is 51 years old and was diagnosed with nonalcoholic cirrhosis 3 months ago. Her recent MELD score is 29. She has been in and out of the hospital with pleural effusion and requires thoracentesis to drain the excess fluid. My uncle has ran out of vacation days and has to work in the day time not only to maintain their insurance coverage but to support their family, but he returns to the hospital every evening to the hospital to support her. The liver team at the hospital visited her while my uncle was at work and their getting concerned about the level of support she has since he is not at her bedside 24/7. They will not give her a liver if they don’t think she has the support she needs. So is this a medical necessity for a liver transplant to have someone with these candidates 24/7? This is just beyond my comprehension. Family members must earn a living. She will have the support after the transplant. My uncle has 12 weeks of unpaid medical leave and is planning to take these after her transplant and if he takes these now, the days could possibly be used up by the time the transplant takes place. Can you please explain the reasoning behind this, so our family can understand?

  31. JennyInTx 04/03/2016 at 2:09 pm #

    My mother is between 8-13 on meld score. She is very sick and undergoing many complications for instance. Portal hypertension.. Acites..Hepatic encephalopathy.. Hydrothorax ” plural infusion and a very painful umbilical hernia… on top of diabetes high blood pressure and now they’re suspecting congestive heart failure.. how is it she develops so many complications and her meld scores tend to stay about the same for the past two years

  32. priya 05/05/2016 at 12:13 pm #

    what is the average meld score to get liver transplantation.

    • Dr. Joe Galati 06/23/2016 at 4:55 pm #

      It all depends on what part of the country you live in.

  33. MJKLAP 05/21/2016 at 11:51 am #

    Dr. Galati,

    My 68 year old husband was diagnosed with ESLD in July, 2016. At that time he was in a hepatic coma, with a MELD of 30. A wonderful ICU doc brought him out of the coma (after several hospitalists told us to just let him die), and for the past 9 months his MELD has ranged between 10 and 16. We are consulting with a major transplant center, but he is not on the list yet.

    My question for you is, does continuing muscle wasting indicate cause for concern in terms of prognosis? His liver transplant center doc has him on a 6 month checkup schedule, but the muscle wasting seems to be accelerating. He is reasonably compliant with diet and meds, but has recurrant ascites, and easily slips into Grade I or II HE if he misses a dose of Lactulose. It’s a constant battle to manage the ascites with a diuretic and a beta blocker without dangerously affecting his renal function and potassium levels. He tries to exercise but he is in so much pain from the muscle wasting that sleeping is problematic, much less exercising.

    • Dr. Joe Galati 06/23/2016 at 4:54 pm #

      You outline the issues many liver patients, and caretakers face. Liver disease is a wasting condition. The ascites is contributing to his malnutrition and wasting. Transplant will reverse this all.

  34. Jenny 06/04/2016 at 12:11 pm #

    My husband was turned down by Jewish hospital in Louisville for a liver transplant after going through the evaluation two months ago his mailed score is 18 but he has a pacemaker and a defibrillator her obviously he has heart issues he’s 52 years old and I’m not sure what to do next and I’m very scared I’ve just started noticing some confusion with him but I’m not sure if it’s because he doesn’t eat right which she doesn’t because he’s nauseated I want the has a hernia is well I don’t know what to do next any suggestions would be appreciated we have a liver doctor Who has put bands on the esophagus do Diversey’s twice in six months but he just did a scope and he said we don’t have to return for a year he’s also had three belly taps for the paracentesis but nothing in the last two months symptomatic Lee he’s doing better but yet no energy not much exercise He has been trying to eat a little better hoping that improves things how often should we check the milk score He has mesh leave known about it about a year and a half after he had his heart attack

  35. Doug Nearing 06/27/2016 at 10:10 pm #

    Almost bled out August 2015. They put a tipps in and I have been in and out of hospital numerous times for ensepalahly. Last 5 months been staying out of the place. I just completed 6 months of hep c meds. Have a 15 meld score right now

  36. Candy Ide 01/01/2017 at 8:21 am #

    I have a 28 year old daughter that has autoimmune hepatitis with cirhossis. We have been dealing with a living donor hospital which her father has been approved as a living donor. The hospital refuses to do the living donation transplant without us subjecting our daughter to the Tips procedure. From my research is see no benefit to this procedure, in fact I feel as it puts her in a risky situation. Her platlettes are very low, her inr is high, she already has frequent encepholophy. I just don’t understand why they want to risk this. Everyone I have talked to that has had the procedure has nothing good to say about it. I know of one young lady that did not survive the procedure. My daughter also has a meld score that bobbles between 14 and 15. But again is much sicker than the score reflects.

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