The advantages of the MELD score are its statistical validation, in contrast to CTP score, and use of objective and widely available laboratory tests ( Table 3). Despite its wide spread adoption, data on calibration of MELD score have not been published. MELD score may either increase or decrease with time and individual patient scores are forwarded regularly by each transplant center ( ). Patients are ranked according to their MELD score and stratified by blood type. Recent changes in UNOS policy require liver donor offers first to patients with MELD scores ≥15 within a region, before offers to local candidates with MELD <15 (Share 15 Policy). However, as we have published, CTP and MELD are equivalent in terms of their discriminative capacity as prognostic scores whether in LT candidates or for cirrhosis in general, even with the addition of new studies. The MELD was adopted in the USA from 27 February 2002 and has evolved following close audit and validation. In 2001, the same group, slightly modified this score to predict mortality for cirrhosis: the MELD score had discriminative ability for 3-month survival of greater than 80%, regardless of the severity of liver disease, without any significant improvement by adding etiology or complications of cirrhosis. The MELD model was first published in 2000 to predict survival in patients undergoing transjugular intra-hepatic porto-systemic shunt (TIPS). Well-designed prospective studies and simulation models are necessary to establish the optimal allocation system in liver transplantation, as no current model has all the best characteristics. These models would be based on the maximization of the lifetime gained through liver transplantation. The transplant benefit models rank patients according to the net survival benefit that they would derive from transplantation. MELD and UKELD scores poorly predict outcomes after liver transplantation due to the absence of donor factors. The utility-based systems are based on post-transplant outcome taking into account donor and recipient characteristics. Adjustments to the original MELD equation and new scoring systems have been proposed to overcome these limitations incorporation of serum sodium improves its predictive accuracy and is part of the UKELD score. However, both scores have important limitations. The MELD and UKELD scores have statistical validation and use objective and widely available laboratory tests. With an urgency policy, patients with worse outcomes on the waiting list are given higher priority for transplantation.

Policies for organ allocation can be based on medical urgency, utility or transplant benefit.

Meld score range mortality