The Bottom Line: The MELD (model for end-stage liver disease ) score was introduced in Germany in 2006. Recently data has shown that mortality has decreased on the waiting list but there has also been a decrease of post-transplant survival. There are a few components discussed to be responsible; although, a MELD >30 is known to be major risk factor for outcome, MELD scores have increased to over 30 since its introduction. However, the donor quality of organs is deteriorating from year to year at the same time.
Bahra. Liver transplantation in the high MELD era: a fair chance for everyone? Langenbeck’s archives of surgery 2011 vol:396 iss:4 pg:461 -465
Summary: Liver transplantation is a well-established therapy for patients with end-stage liver disease The serious shortage of liver allografts is a major issue. MELD was introduced to ensure a thorough and transparent allocation. This resulted in a decrease of mortality on the waiting list, but also to an unfortunate decrease of the 1-year survival from 90% to less than 80%. . Since the introducing MELD, the matchMELD threshold in Germany increased from 25 to 34. However, concurrently a continuous deterioration of organ quality was observed over the last 10 to 15 years. In order to improve this, several strategies were discussed, including the decrease of organ availability or eliminating inappropriate incentives for transplant centers.