Preparing for Liver Transplant

After you're listed for a liver transplant, your wait time may range from weeks to months. In New England, the average wait is about one year but at BIDMC, the waiting time can be as short as a few weeks to a few months. Placement on the waiting list is determined by your MELD score, not how long you’ve been waiting.

Your MELD Score (Now MELD 3.0)

Your placement on the liver transplant waitlist is based on a scoring system called the Model for End-Stage Liver Disease, or MELD. This score predicts how urgently you need a transplant by estimating your short-term risk of death from liver disease.

In 2023, UNOS updated this system to MELD 3.0 to improve fairness and accuracy—especially for women and patients with certain types of liver disease. MELD 3.0 is based on the following lab values:

•  INR (a measure of your blood’s ability to clot)
• Serum bilirubin (shows how well your liver is clearing waste)
• Serum creatinine (a measure of kidney function)
• Serum sodium (important for fluid balance and liver disease severity)
• Sex at birth (to adjust for known disparities in scoring for women)

Scores range from 6 to 40, with higher scores indicating more severe illness. Your score can go up or down over time as your condition changes. The higher your MELD score, the higher your priority for receiving a transplant.

If your MELD score doesn’t fully reflect how sick you are, your transplant team can request an exception score—a formal process that considers additional medical information to adjust your position on the list.

You can always ask your team to explain your current MELD 3.0 score and what it means for your transplant timeline.

Being Listed at Multiple Transplant Centers

While BIDMC will serve as your primary transplant center, you may also choose to be listed at other transplant centers across different regions or transplant centers. The Organ Procurement and Transplantation Network (OPTN), managed by UNOS, permits multiple listings as long as the centers. Not all programs allow this, but the BIDMC Transplant Institute supports multiple-listing candidates. You will need to be evaluated separately at each center. Please check with your insurance provider about coverage for additional evaluations.

If you have concerns about your care or listing status, you can contact UNOS at 888-894-6361.

Deceased Donor Livers are categorized into two main groups:

• Donation after brain death (DBD): These livers come from brain-dead donors with otherwise healthy organs. Brain death is confirmed through neurological exams or imaging, and the donor is legally deceased, though their heart may still be beating with life support.
• Donation After Cardiac Death (DCD): These donors do not meet criteria for brain death but have suffered irreversible brain injury. Once life support is withdrawn and there is confirmation that the heart has stopped , organ donation may proceed.

BIDMC is a national leader in safely using all deceased donor types. Our transplant team is on call 24/7 and works swiftly to optimize outcomes by transplanting organs as quickly as possible.

Your Pre-Transplant Care

While you’re on the waitlist, you will have regular visits with our team to:

• Monitor your disease progression
• Screen for complications
• Optimize your overall health
• Keep you ready for transplant

You’re encouraged to bring a support person to each appointment for support and communication.

Our goal is to prevent or manage complications of advanced liver disease, including:

• Ascites & Bleeding Varices: Fluid buildup and bleeding from enlarged veins
• Coagulopathy: Impaired blood clotting leading to bleeding risks
• Hepatic Encephalopathy: Confusion due to toxin buildup in the blood
• Hepatorenal Syndrome: Kidney failure triggered by liver failure
• Spontaneous Bacterial Peritonitis: Infection in abdominal fluid  

Caring for Your Whole Self

We believe in treating the whole person—not just the disease. That’s why we offer:

• Psychosocial Support: Counseling and emotional care
• Transplant Support Groups: Connect with others navigating transplant journey.

To stay as healthy as possible while waiting, we recommend:

• Exercising to your ability
• Following a liver-healthy diet
• Taking all medications as prescribed
• Keeping up with regular appointments

Living donor transplants often lead to shorter wait times with excellent outcomes. These livers typically begin functioning immediately. To be eligible for a living donor transplant, you must:

• Be listed on the UNOS waitlist for deceased donor liver
• Have a functioning portal vein
• Be eligible even with a TIPS procedure
• Not have a blood clotting disorder

You may choose to talk with family or friends about living donation—or ask someone close to help start the conversation. It's not always easy, but many are willing to help when they understand the need.

Key Points About Living Donor Compatibility:

• Blood type compatibility—not identical match—is what matters
• Group O donors can give to anyone
• The donor evaluation process is private and confidential

Behavioral health specialists are available to support both you and your loved ones throughout this process.