Right now, nearly 17,000 people in the United States await a liver transplant; more than 1,500 people die each year while waiting. A recent opinion piece in The Washington Post asks why and recommends a radical alternative to how livers are currently allocated: Stop prioritizing MELD scores and first consider the cause of liver disease in potential patients before allocating organs.
Written by Joshua Mezrich,
Mezrich notes that for the most part, patients at the top of liver transplant waiting lists have one of three diagnoses: alcoholic liver disease (ALD), non-alcoholic steatohepatitis (NASH) or hepatitis C virus (HCV). Less common are patients suffering from rare primary liver diseases, which occur
Mezrich recalls a medical student of his named Nate who had primary sclerosing cholangitis,
Mezrich suggests a better protocol would favor transplanting livers into people with primary liver diseases, which represent only about 10 to 15 percent of cases, because, Mezrich points out, the main treatment for these patients is a transplant. The rest of the livers, he says, could then be allocated based on MELD scores and other factors, such as the new liver transplant distribution rules set forth by the United Network
Whether this is fair to patients with ALD, NASH or HCV—who might have developed liver disease as a result of alcoholism, obesity or injection drug use—is questionable. But the article does highlight the ongoing debate regarding just how much weight a MELD score carries when people are awaiting a liver for transplantation.
To learn more about how liver transplants are distributed in the United States, click here.