Cox News Service

Will I die waiting? For the nearly 18,000 Americans needing a liver transplant, it's a haunting question as demand continues to greatly outstrip supply.

This week, liver specialists in Atlanta for a medical conference debated proposed changes in the current transplant system that could mean shorter waits for the sickest patients and fewer people dying. The changes would require that transplant officials no longer consider the length of time a patient has been on a waiting list in determining who receives a liver. Instead, livers would go to those most at risk of death, based strictly on a standardized medical evaluation.

In November, the United Network for Organ Sharing (UNOS), the national group that oversees transplant policy, recommended the new system, called MELD, or Model for End-Stage Liver Disease. The proposal has been submitted to the U.S. Department of Health and Human Services, which must approve it. The system would assign each patient a score of need based on three standardized tests measuring blood-clotting ability, liver function and kidney function.

These tests, along with other tests and observations that are considered more subjective, are used by doctors to assess a patient's possibility of death if a transplant is not performed within three months.

How long a patient has been on the waiting list also currently is taken into consideration. That has led to scenarios in which healthier patients have received livers over sicker patients because they had been wait-listed longer, said Dr. Russell H. Wiesner, a transplant physician at the Mayo Clinic in Rochester, Minn.

"Using MELD, the guy with the sickest liver is going to get a new organ and the guy who is not as sick is going to have to wait. Right now, it's almost flip-flopped," Wiesner said.

Research presented at the Atlanta conference provided conflicting evidence that the MELD criteria can accurately predict which patients with chronic liver disease are at greatest risk of death without a liver transplant.

One study found the MELD model accurately predicted mortality when applied to patients listed for transplants. But a second study provided mixed results.

Over the next nine months, UNOS will continue to study the MELD scoring system.

Dr. Thomas Heffron, director of the Emory University Hospital Transplantation Center, said he is not convinced MELD will solve the basic dilemma: that not enough people sign up to be organ donors.

"Using MELD takes the decision process even more out of the hands of physicians, and it means patients have to be sicker to move to the top of the list, so there's a greater chance they won't survive the transplant," he said.

National statistics show the odds are stacked against people facing death due to chronic liver disease. Each year, about 25 percent of people waiting for a liver transplant will get one.

Nationally, only 4,934 people underwent a liver transplant last year, leaving some 10,000 others still listening for their transplant team pager to go off. An additional 1,756 died waiting.

Copyright 2001 Cox News Service. All rights reserved.