Liver transplantation in the high MELD era: a fair chance for everyone?

INTRODUCTION: In 2006, the model for end-stage liver disease (MELD) was introduced in Germany. Recent data clearly show a decrease of mortality on the waiting list but also a decrease of post-liver transplant survival. Several factors are discussed to be responsible for that; although, a MELD >30 is known to be major risk factor for outcome, MELD scores have increased to over 30 since introduction of the MELD system. On the other hand, the quality of donor organs is deteriorating from year to year at the same time.

RESULTS: To date, we have to face the dilemma of organ allocation to significantly sicker patients resulting in a noticeably worsening of post-orthotopic liver transplant (OLT) results. The question is how to keep an acceptable standard of post-OLT results.

CONCLUSION: Should allocation guidelines be modified? A further significant question is: How fair is the current allocation system for patients on the waiting list? Does the MELD score privileges or discriminates potential organ recipients?