Question

To complete this Individual Preparation assignment, answer the following questions related to this week’s two cases. Each answer should be no more than 1-2 sentences.

1. According to their MELD scores, which patient is the worst-off (in the most need), and which patient can wait the longest for a transplant? Explain.

2. Given the criteria for assessing post-transplant success, such as the patient’s lifestyle choices and support system, which patient has the highest likelihood of success, and which patient has the lowest likelihood of success? Explain.

Assigning Priority for Liver Transplantation
Liver failure can result from many causes. Some patients have failing livers as a result of an inborn condition called biliary atresia, a blockage in the liver that causes liver failure. Other causes
involve problematic behaviors—exposure to toxic chemicals, drugs, or a diet high in salt, sugar,
and fat. Alcohol consumption is also a major cause of liver failure and the need for a transplant.
It is estimated that up to 35% of alcoholics have alcoholic hepatitis. Some patients with alcoholic
hepatitis have a complete recovery from liver disease when they stop drinking. However, for 10-
15% of patients with alcoholic hepatitis this develops into cirrhosis of the liver, a major cause of
death in the United States.
In terms of health outcomes, data shows similar long-term survival rates for both recoveringalcoholic and non-alcoholic transplant recipients. Roughly 20% of recovering-alcoholic transplant
recipients use alcohol following their transplant, with only 5% of recipients exhibiting “repetitive
or heavy drinking.” Non-alcoholic transplant recipients also engage in similar rates of alcohol
consumption following transplantation.
The yearly demand for liver transplants far exceeds the supply of available organs. Currently,
livers are allocated on a point system called a Model End Stage Liver Disease (MELD) score,
which indicates the patient’s likelihood of mortality within 3 months without a liver transplant.
MELD Score Probability of Mortality within 3-Months
6-19 6-18% likelihood of mortality
20-29 19-52% likelihood of mortality
30-39 53-70% likelihood of mortality
40 > 70% likelihood of mortality
A higher MELD score indicates a patient in greater need of a liver transplant. In order to determine
the likelihood of a successful transplant, transplant teams also assess a patient’s “support system”
as an indication of whether the patient will be able to comply with important post-operative care
or refrain from risky behaviors post-transplant. There is also a requirement that recovering
alcoholics must remain sober for six months prior to being put on the transplantation list.
Your team is part of the Transplant Selection Committee at Cleveland State Hospital. The
committee meets weekly to re-assess current patients and to determine whether and in what order
new patients should be added to the transplant list. At today’s meeting you have five new patient
files to consider.
Patient A: Al
Al, 65 year old male, is assessed to have a MELD score of 19. It is determined that his liver failure
is a result of cirrhosis caused by Hepatitis C. Individuals can live with chronic Hepatitis C for
roughly 30 years before it develops into cirrhosis. When interviewed as part of his transplant
evaluation, he explained that he contracted Hepatitis C in his late 20’s from a tattoo while he was
serving in the army. He has a strong social support network including his wife of 35 years, four
children, and six grandchildren.
Patient B: Bree
Bree, 36 year old female with a history of alcoholic cirrhosis, is assessed to have a MELD score
of 39. For the past six months she has been attending Alcoholics Anonymous (AA) meetings and
has been maintaining contact with her AA sponsor twice weekly. The report from her AA sponsor
indicates that Bree has been sober for the past six months, except for a few sips of Champagne at
her sister’s wedding two months ago. Bree had also been enrolled in a formal rehabilitation
program but did not complete it as she became too ill and required hospitalization. She has been
in the ICU for two weeks. Bree’s spouse and 16 year old daughter have written a letter to the
transplant team pleading with them to approve her for the waiting list.
Patient C: Chance
Chance, 22 year old male, was brought to the emergency department by his neighbor. He is
jaundiced, encephalopathic, and required emergency intubation. He has been transferred to the
intensive care unit (ICU) and evaluated by the hepatology team. Unfortunately, the exact cause of
his acute liver failure is unknown. Based on his liver function, his MELD score is 32, but after five
days of monitoring in the ICU, the team care determines that a liver transplant will be necessary
to stabilize his condition and off a hope for curing him. Thus far the healthcare team has been
unable to contact any family for Chance, so his home-support situation cannot be assessed.
Patient D: Diana
Diana, 55 year old female, is assessed to have a MELD score of 24. When interviewed as part of
her transplant evaluation, she admitted that she used drugs and drank heavily during her college
years, but completed an alcohol rehabilitation program when she was 30. She has documented
sobriety for the past 25 years. However, her husband of 20 years meets the criteria for being alcohol
dependent, raising concerns that she lacks a strong support system. She has no children or local
relatives to help her with post-op care.
Patient E: Etta
Etta, 19

Answer 1

1)Based on MELD score, patient B i.e Bree with MELD score 39 is in the most need for liver transplant and the patient A with MElD score 19 because higher the MELD SCORE, higher is the need and vice versa.

2) Patient A has the highest likelihood of success as because he contracted hepatitis C in his 20's and now he is already 65 and also he have a strong social support to help him.

Patient C has the lowest likelihood of success because he was brought to emergency and later shifted to ICU , also had jaundiced and encephalopatic. And also the healthcares thought about the same as there is little hope. Adding to that, his social support chouldnt be assesed too.