Or, more accurately, the acronym for the day. MELD is the shorty version of Model for End Stage Liver disease (see why they needed a shorty?). This is a score that patients with liver disease are given based upon three factors and indicates one's probability of survival for a determined amount of time.
I suppose the first thing to mention is the liver and it's function. The liver is the one of the largest organs in the body, weighing in at about 3# (similar to your brain), but less than your skin (8-10#). This may not seem huge, but when we consider the important role of the liver in sustaining life, the old adage applies--size doesn't really matter.
As most of us know, the liver one of the cleansing organs of the body (along with the kidneys), filtering out harmful substances from the blood, as well as helpful substances that in too great a quantity would become harmful. However, it has a much greater role than is commonly realized.
The primary functions of the liver are:
Bile production and excretion
Excretion of bilirubin, cholesterol, hormones, and drugs
Metabolism of fats, proteins, and carbohydrates
Enzyme activation
Storage of glycogen, vitamins, and minerals
Synthesis of plasma proteins, such as albumin, and clotting factors
Blood detoxification and purification
Okay, so back to the MELD score. The three factors are~
Bilirubin: The by-product of the liver's breakdown of red blood cells (red blood cells are recycled by our bodies about every 120 days). It's yellowish-brown in your bile, makes your poop brown (yes, I do think you should use that as a conversation starter at your next dinner party!) and if you have too much, like when your liver is not working right, your skin and the whites of your eyes begin to look much daffodil yellow than Lilly white.
Serum Creatinine: This is a measurement of kidney function. Kidneys and livers apparently like to party and get into trouble together, i.e. they will often both have problems at the same time.
INR~(International Normalized Ratio, previously know as a prothrombin time, or protime for those of the medical persuasion): This is a measure of how long it takes the blood to clot, and is important since the liver is responsible for the production of clotting factors. Without those, blood will not stop bleeding once it has started, and this is BAD.
You must have a MELD of at least 10 to be considered for liver transplant. The scale runs from 10-40. Right now, Alex is at 15, which means he needs to have labs done more frequently and he is eligible for consideration of transplant. We are being referred to the University of Washington, where they do 80-100 liver transplants per year. As of now, the wait has been about 6 months for a liver, which is awesome, by the way (national average is much greater, around 2-3 years from what I have read). There is no guarantee, however, that Alex will actually need a liver in 6 months after we are on the list (if he is not sick enough), and the wait can be longer. There is not a steady supply to meet the demand and several factors, including size and blood type, as well as MELD score, are considered.
The Process
Basically, we are referred to the U, they do a 4 hour intake interview and decide if we should be considered for transplant. If they say yes, we will return for two days of testing (including EKG's, blood work, etc.), meetings (with doctors, nurses, and financial counselors), etc. to gather all the information for the Review Board. The Review Board will determine if we are appropriate to be "listed". If they do (and we hope they do!) then we will be placed on THE LIST and then--wait. This is a hard thing, because A)no one likes to wait for anything--just think of pregnancy, most of us would gladly just have the baby! B)it's very unpredictable, a call can come any time, day or night, and C)somebody else and their family are having an awful day if you are having a good one. The U does only deceased (aka cadaveric) donor transplants, and there is a degree of sadness which accompanies the joy that you feel.
So, Can't Alex Just Have a Part of My Liver?
Yes, and no. Liver matching is based primarily on size and blood type. However, there are only 5 locations in the USA that do live donor transplants for livers (kidney's are much more commonly done that way these days). Amazingly, nearly everyone we have spoken to has offered this, though, and what a loving gift! Although it will likely not be the route we take, it is a blessing to know we are so cared for by so many that would be willing to take on that task. THANK YOU!
Until next time, God Bless you and keep you!!
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