It is a dynamic score that changes over time. 1 The Final Rule prompted the need for a validated objective score for liver transplant prioritization with the aims of eliminating subjective bias.ĭespite its improved predictive ability of mortality in cirrhosis, MELD-Na still has limitations. In 2000, the Final Rule, which was devised by the United States Department of Health and Human Services, sought to ensure justice by allocating organs equitably across geographic regions and prioritizing transplantation based on medical urgency defined by objective standardized criteria. In addition, the subjective components of the CTP score, namely, the presence and degree of ascites or encephalopathy, allowed for inappropriately scoring the severity of a patient's condition to benefit his or her position on the waitlist. For example, it allowed for patients to be admitted into the hospital to increase their priority on the waiting list even without a true indication for admission. However, these methods of prioritization allowed for manipulation of the system through loopholes, which led to unfair prioritization of patients on the waiting list. Before the inception of the MELD score, priority on the liver transplant waiting list was based on hospitalization status, time on the waitlist, and eventually the Child-Turcotte-Pugh (CTP) score and its iterations. Understanding the evolution of MELD is key to learning transplant allocation policy.
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