Improving liver allocation: MELD and PELD

Richard B. Freeman, Russell H. Wiesner, John P. Roberts, Suzanne McDiarmid, Dawn M. Dykstra, Robert M. Merion

Research output: Contribution to journalReview articlepeer-review

193 Scopus citations


On February 27, 2002, the liver allocation system changed from a status-based algorithm to one using a continuous MELD/PELD severity score to prioritize patients on the waiting list. Using data from the Scientific Registry of Transplant Recipients, we examine and discuss several aspects of the new allocation, including the development and evolution of MELD and PELD, the relationship between the two scoring systems, and the resulting effect on access to transplantation and waiting list mortality. Additional considerations, such as regional differences in MELD/PELD at transplantation and the predictive effects of rapidly changing MELD/PELD, are also addressed. Death or removal from the waiting list for being too sick for a transplant has decreased in the MELD/PELD era for both children and adults. Children younger than 2 years, however, still have a considerably higher rate of death on the waiting list than adults. A limited definition of ECD livers suggests that they are used more frequently for patients with lower MELD scores.

Original languageEnglish (US)
Pages (from-to)114-131
Number of pages18
JournalAmerican Journal of Transplantation
Issue numberSUPPL. 9
StatePublished - Jul 2004


  • Allocation policy
  • Expanded criteria donor livers
  • Liver transplantation
  • Liver-intestine transplantation
  • MELD
  • PELD
  • Pediatric liver transplantation
  • SRTR
  • Waiting list

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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