Pediatric Liver Transplantation Information for Healthcare Professionals

Chapter 9: Organ Donation And UNOS Criteria

Many parents ask questions about what it means to be “listed” on the transplant list.  A national procurement network, the United Network for Organ Sharing (UNOS), was established for the fair distribution of donor organs.  UNOS is responsible for overseeing and maintaining the liver allocation system. 

PELD system for children age of 11 and under:

The Pediatric End-Stage Liver Disease (PELD) is a numerical scale that is currently used for liver allocation among patients age eleven and under.  The status of each patient is determined by the PELD score.  On a regular basis, patients are required to submit blood work so that Johns Hopkins can submit the latest test results to UNOS and ensure that your child has an accurate PELD score. 

PELD scores are based on these lab results:

1. Bilirubin: which measures how well the liver processes bile

2. Creatinine: which measures kidney function

3. INR: which measures liver’s ability to make blood clotting factors

4. Sodium level

5. Albumin: which measures the liver’s ability to maintain nutrition

6. Growth failure

7. Whether the child is less than one year old

MELD system for children age of 12 and over:

The Model for End-Stage Liver Disease (MELD) is a numerical scale that is currently used for liver allocation among patients aged twelve and over.  The status of each patient is determined by the MELD score.  On a regular basis, patients are required to submit blood work so that Johns Hopkins can submit the latest test results to UNOS and ensure that your child has an accurate MELD score. 

MELD scores are based on these lab results:

1. Bilirubin: which measures how well the liver processes bile

2. Creatinine: which measures kidney function

3. INR: which measures liver’s ability to make blood clotting factors

4. Sodium level

When a potential donor becomes available, these criteria are used to match a donor and recipient.  Donor organs are initially offered to local recipients.  If no match is found, the donor organs are offered to regional or national recipients.  Time spent on the list is not as important as MELD/PELD score, which measures the severity of illness.

If you have questions or need more information, contact your transplant coordinator or visit the UNOS website to download their patient resource manual “MELD/PELD Overview Q & A” at http://www.optn.org/resources/meldpeldcalculator.asp