Lahey Transplant - Liver Recipient

7. Be Added to Liver Waitlist

You’ll be added to the organ waitlist after the evaluation committee finds you a suitable candidate for transplantation. We’ll add you even if you have a living donor planned as a safety measure so no time is wasted in case the donor is declined. Your priority on the waitlist is determined by location, blood-type, and the severity of your condition.

Waitlist Priority Criteria

The United Network for Organ Sharing (UNOS) is the national organization in charge of administering and allocating organs from deceased donors. They use four different criteria to rank the priority of organ candidates. These criteria are outlined below, by level of importance:

1. Location

Available organs are allocated within their local region. The US is divided into 11 regions, each with its own supply and demand. Lahey Hospital is part of UNOS Region 1, which includes most of New England.

2. Blood Type

Within each region, the liver transplant waitlist is divided into four different lists separated by blood type: O, A, B, and AB. The + or - after the blood type is not a factor in liver transplant, so an O+ person can donate to an O- recipient.

3. Urgency of Condition

Within each blood-type list, people are ranked by urgency of medical condition: the MELD score. The higher your score, the more life-threatening your liver disease is. It is used to determine who needs a liver the most. We outline details of MELD in the section below.

4. Liver Size

Another consideration in organ allocation is your body size. The donor liver has to have an adequate volume for the transplant to be a success. If you’re a large person, getting a small liver won’t provide you with sufficient function.

UNOS forbids organ allocation based on any other factors. These may include age, sex, race, or socioeconomic status. It is also illegal to purchase an organ. Time spent on the waitlist has not been a factor since the MELD score was established in 2002. For example, someone with a very high MELD score may come into the waitlist and get a liver while “passing” people that have been waiting longer with a lower MELD score.

The MELD Score

MELD stands for Model for End-Stage Liver Disease. It's a mathematical score that combines three blood tests (Bilirubin, INR, and Creatinine) to determine the severity of your liver disease. This score ranges from 6 (normal liver function) to 40 (severe illness), and it is used to prioritize patients on the waitlist. The three blood tests to determine MELD are:

Bilirubin Test

This blood test measures how effectively your liver excretes bile. When bilirubin content is high in the blood, your skin and eyes may appear yellow, or jaundiced. The higher your bilirubin levels, the higher your MELD score will be.

INR Test

The International Normalized Ratio, or INR, is a blood test that measures the clotting tendency of your blood. A high INR indicates that your liver isn't producing enough blood-clotting factors into the bloodstream, which is an indication of liver failure.

Creatinine Test

Creatinine is a waste product from your muscles, typically found in the bloodstream. This blood test tells us how well your kidneys are filtering creatinine. If your creatinine levels are high, it indicates that your kidneys are malfunctioning, which is associated with liver disease.

Cancer, Tumors, etc.

If you have other conditions, you may a have normally-functioning liver, thus leading to a low MELD score, yet you’ll have an urgent necessity for a liver transplant. UNOS has solved this problem for these patients by giving them an automatic MELD score of 22. For every three months that they go without a liver transplant, their MELD score will increase.

Waitlist Rules

In order to remain active on the liver transplant waiting list, it is essential that you understand and fulfill the responsibilities outlined below. Failure to follow these rules may harm your position on the waitlist, or in extreme cases, it may lead to your removal from the list altogether.

Keep All Appointments

You must keep all scheduled appointments at Lahey Hospital so we may track your condition, and take appropriate action in case it worsens. If you cannot make it to your appointment, we appreciate you give us a call so we may accommodate other patients.

Obtain Tests

It's your responsibility to obtan laboratory and radiology tests according to the schedule you will be given. This schedule is a UNOS regulation and it is extremely important that you adhere to it so we may update your MELD score accordingly. Failure to do so will result in being ineligible for a liver transplant.

Abstain from Drugs & Alcohol

Your liver gets damaged every time you consume these substances, so we ask you to take care of it while on the waitlist so your condition doesn’t deteriorate. We’ll perform random drug and alcohol tests to ensure you’re following this guideline.

Keep Lahey Informed

You or a family member should inform us if you experience any important health events, such as an infection, a visit to the emergency room, or admission to another hospital. You should also let us know if there are any changes to your address, phone number, or insurance coverage.

Multi-Center Listing

Unos allows multi-center listing, which means you may choose to be listed in at as many transplant centers as you desire. This increases the likelihood you’ll receive a liver on time. Make sure you check with your insurance company first, and also take travel and lodging costs into consideration, as you will need to travel and stay near the hospital where the liver becomes available.

If you choose to participate in multi-center listing, we recommend you don't list twice in the same region; Multi-listing in one region will not provide an advantage because all transplant centers in that region will share the same organ supply.