Steve Jobs Opens Up About Liver Transplant at Apple Event

An Objective Way to Make Liver Recipient Lists?

"It's an objective score that is generated from patient's blood test to better be able to rank people in the severity of their illness," said Dr. Ari Cohen, a transplant surgeon with the Ochsner Health System in New Orleans.

"The MELD score makes it purely objective, and it's the same between centers," he said.

MELD scores range from a low point of 6 to a severe near-death score of 40. The sicker one gets, the higher the MELD score goes. At a MELD score of 15 or above, doctors begin to recommend a transplant.

But once the MELD score was implemented, a clear geographic difference among waiting lists began to appear, according to Dr. Michael Porayko, medical director of liver transplant at Vanderbilt University in Nashville, Tenn.

"There are differences in wait times for livers," said Porayko. "I know for instances at the Mayo Clinic down in Florida, there are so many donors they can transplant somebody at a MELD of 17, 18, 19."

At Vanderbilt the average MELD score at time of transplant ranks around 24. But on the East and West coasts, Porayko said, the average transplant is done with a person who has a MELD score of 30.

But the original MELD score isn't always used to gauge a patient's needs if the disease that's causing the liver failure won't show symptoms in the MELD blood tests. In the rare case of someone with islet cell cancer, for example, the patient would be reviewed by a regional board that would then assign an "artificial" equivalent MELD score, said Cohen.

It's unknown whether Jobs fell into this category and what such a score might have been since he is not releasing his medical records.

Despite the cases of the wealthy benefiting from multiple listings, Cohen said he thinks the MELD system has so far proven the best method for fair organ transplants.

"People are constantly looking at ways to improve upon organ availability," said Cohen. "None of them are proven yet, so they haven't been applied. This system is the best system we have right now."

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