title: Model for end-stage liver disease exceptions in the context of the French model for end-stage liver disease score-based liver allocation system.
abstract: Model for End-Stage Liver Disease (MELD) score-based allocation systems have been adopted by most countries in Europe and North America. Indeed, the MELD score is a robust marker of early mortality for patients with cirrhosis. Except for extreme values, high pretransplant MELD scores do not significantly affect posttransplant survival. The MELD score can be used to optimize the allocation of allografts according to a sickest first policy. Most often, patients with small hepatocellular carcinomas (HCCs) and low MELD scores receive extra points, which allow them appropriate access to transplantation comparable to the access of patients with advanced cirrhosis and high MELD scores. In addition to patients with advanced cirrhosis and HCC, patients with a number of relatively uncommon conditions have low MELD scores and a poor prognosis in the short term without transplantation but derive excellent benefits from transplantation. These conditions, which correspond to the so-called MELD score exceptions, justify the allocation of a specific score for appropriate access to transplantation. Here we report the conclusions of the French consensus meeting. The goals of this meeting were (1) to identify which conditions merit MELD score exceptions, (2) to list the criteria needed for defining each of these conditions, and (3) to define a reasonable time interval for organ allocation for each MELD exception in the general context of organ shortages. MELD exceptions were discussed in an attempt to reconcile the concepts of transparency, equity, justice, and utility.
authors.affiliation: Departments of Hepatology, Beaujon Hospital, Clichy, France. claire.francoz@bjn.aphp.fr
authors.forename: Claire
authors.initials: C
authors.lastname: Francoz
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.forename: Olivier
authors.initials: O
authors.lastname: Chazouillères
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Duclos-Vallée
authors.forename: Christophe
authors.initials: C
authors.lastname: Duvoux
authors.forename: Jan
authors.initials: J
authors.lastname: Lerut
authors.forename: Yves-Patrice
authors.initials: YP
authors.lastname: Le Treut
authors.forename: Richard
authors.initials: R
authors.lastname: Moreau
authors.forename: Ameet
authors.initials: A
authors.lastname: Mandot
authors.forename: Georges
authors.initials: G
authors.lastname: Pageaux
authors.forename: Didier
authors.initials: D
authors.lastname: Samuel
authors.forename: Dominique
authors.initials: D
authors.lastname: Thabut
authors.forename: Dominique
authors.initials: D
authors.lastname: Valla
authors.forename: François
authors.initials: F
authors.lastname: Durand
mesh_terms: D003245:Consensus Statements as Topic; D003661:Decision Support Techniques; D058625:End Stage Liver Disease / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D005602:France; D006305:Health Status Indicators; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014850:Waiting Lists