Improving liver allocation: MELD and PELD


  • Notes on Sources: The articles in this report are based on the reference tables in the 2003 OPTN/SRTR Annual Report, which are not included in this publication. Many relevant data appear in figures and tables included here; other tables from the Annual Report that serve as the basis for this article include the following: Tables 9.1, 9.2, and 9.3. These tables are also available online at

  • Funding: The Scientific Registry of Transplant Recipients (SRTR) is funded by contract #231-00-0116 from the Health Resources and Services Administration (HRSA). The views expressed herein are those of the authors and not necessarily those of the US Government. This is a US Government-sponsored work. There are no restrictions on its use.


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.