title: Impact of the Model for Endstage Liver Disease score on liver transplantation.
abstract: OBJECTIVE
  Allocation of deceased donor livers for transplantation is currently based on the Model for Endstage Liver Disease (MELD) score, which has fundamentally changed liver transplantation since its implementation in 2002. This review discusses the development, impact and problems associated with the system.
  
  
  RESULTS
  The MELD system was developed to provide a more objective means of prioritizing candidates for liver transplantation and to allocate livers based on greatest medical need. Liver allocation based on MELD score has had a remarkable effect, such as reducing waiting list mortality and increasing transplantation among patients with greater severity of illness, without a measurable decrement in postoperative survival. Unfortunately, potential problems have been identified. These include wide variation in illness severity in recipients; significant variation in MELD score depending on the clinical laboratory utilized to measure international normalized ratio; and a three-fold increase in the number of liver-kidney transplant recipients.
  
  
  CONCLUSIONS
  While MELD-based liver allocation has resulted in a marked improvement in liver allocation, there are still problems with the system. The challenge for the liver transplantation community is to prospectively evaluate the liver allocation system to ensure it remains the most effective and fair means of allocating deceased donor livers.
authors.affiliation: Division of Gastroenterology/Hepatology, University of Colorado Health Sciences Center, Denver, Colorado, USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Trotter