Calculate the Model for End-Stage Liver Disease (MELD) score for liver transplant prioritization. Based on the official UNOS formula using serum bilirubin, INR, and creatinine.
A patient with compensated cirrhosis has bilirubin 1.2 mg/dL, INR 1.1, and creatinine 0.9 mg/dL.
MELD Score: 8
Risk Category: Low — 3-month mortality: 1.9%
This patient has well-compensated liver disease with a low MELD score and favorable short-term prognosis.
A patient with worsening ascites has bilirubin 3.8 mg/dL, INR 1.7, and creatinine 1.4 mg/dL.
MELD Score: 22
Risk Category: High — 3-month mortality: 19.6%
This patient shows significant hepatic decompensation and should be evaluated for transplant listing.
A hospitalized patient with hepatorenal syndrome has bilirubin 8.2 mg/dL, INR 2.5, and has been on dialysis twice this week.
Creatinine used: 4.0 mg/dL (dialysis adjustment)
MELD Score: 35
Risk Category: Very High — 3-month mortality: 52.6%
This patient requires urgent transplant evaluation given the high MELD score and poor short-term prognosis.
The Model for End-Stage Liver Disease (MELD) score is a validated numerical scale used to assess the severity of chronic liver disease. It predicts 3-month mortality risk and helps prioritize patients for liver transplantation. The MELD score replaced the Child-Turcotte-Pugh (CTP) score for transplant organ allocation in the United States.
| MELD Score | Risk Category | 3-Month Mortality |
|---|---|---|
| < 10 | Low | 1.9% |
| 10–19 | Moderate | 6.0% |
| 20–29 | High | 19.6% |
| 30–39 | Very High | 52.6% |
| ≥ 40 | Critical | 71.3% |
MELD scores should be calculated using the most recent available lab values. Labs drawn within the last 48 hours are preferred for accurate assessment.
MELD scores should be recalculated periodically as liver disease progresses. The score can change rapidly with acute decompensation events.
Always document whether the patient has received dialysis within the past week, as this significantly impacts the creatinine value used in the formula.
Certain conditions (e.g., hepatocellular carcinoma) may qualify for MELD exception points, increasing the allocated score beyond the calculated value.
The Model for End-Stage Liver Disease (MELD) score is a numerical scale that measures the severity of chronic liver disease. Originally developed at the Mayo Clinic to predict survival after transjugular intrahepatic portosystemic shunt (TIPS) placement, the MELD score has been validated as an accurate predictor of 3-month mortality in patients with end-stage liver disease. Since 2002, it has been used by the United Network for Organ Sharing (UNOS) to prioritize liver transplant allocation.
The MELD score uses three routine laboratory values: serum bilirubin (a measure of liver function), INR (a measure of blood clotting ability), and serum creatinine (a measure of kidney function). The inclusion of creatinine reflects the strong prognostic impact of hepatorenal syndrome in liver disease. The formula produces a score from 6 (less severe) to 40 (most severe), with higher scores indicating greater urgency for transplantation.
In the United States, liver transplant allocation follows the "sickest first" principle, where patients with the highest MELD scores receive donor livers first. The MELD score is calculated at the time of listing and updated periodically. Patients with acute liver failure or certain complications (such as hepatocellular carcinoma) may receive MELD exception points to account for their specific mortality risk beyond what the standard formula captures.
The MELD score has largely replaced the older Child-Turcotte-Pugh (CTP) score for transplant allocation because it uses only objective, reproducible laboratory values — avoiding the subjective assessments of ascites and encephalopathy required by the CTP score. This objectivity makes the MELD score more equitable for organ allocation across different transplant centers and regions.
The MELD score is a powerful predictor of short-term mortality in patients with end-stage liver disease. Understanding the risk categories helps guide clinical decision-making:
1.9% 3-month mortality. These patients have well-compensated liver disease and typically do not require immediate transplant evaluation. Regular monitoring is appropriate.
6.0% 3-month mortality. Patients should be referred for transplant evaluation if not already listed. Close follow-up and management of complications are essential.
19.6% 3-month mortality. These patients have significant decompensation and should be actively listed for transplant. Hospitalization may be needed.
52.6% (30–39) to 71.3% (≥40) 3-month mortality. These patients require urgent transplant and often need ICU-level care. Immediate evaluation is critical.
⚠️ Important Medical Disclaimer: This MELD Score Calculator is for informational and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. MELD score calculation should be performed by qualified healthcare professionals using verified laboratory values. Always consult a transplant hepatologist or qualified healthcare provider regarding liver transplant evaluation and management. Do not make medical decisions based solely on the results from this calculator.