Dr. Nevens: Europe is not one country and this may differ in the north of Europe compared to the south. Currently, the main indication for liver transplantation is hepatocellular carcinoma. The etiology of the cirrhotic diseases varies. For example, in France and Belgium, the original liver disease is mostly due to alcoholic liver disease. Hepatitis C is also a major cause and more and more, fatty liver disease.
: Priority on the waiting list was based in the past by the waiting time, and severity of liver disease. The model of end-stage liver disease (MELD) score are used for patient priority. What are advantages and disadvantages in the application of MELD?
Dr. Nevens: As in the United States, most of the liver units in Europe are using the MELD system to give patients priority on the waiting list. MELD is a score based on objective markers including bilirubin, clotting and kidney function. This means that patients who have the highest risk of dying will receive priority and where waiting time is less important. This is in contrast to other organ transplant patients, such as kidney, heart and lung, for example where waiting time is more important. It is a rather fair system. Patients who will benefit most from transplantation have the priority.
However, the problem with MELD is that it was developed for patients with cirrhosis and sometimes the reasons for transplantation can be different. As I said, the main reason for transplant in Europe today is liver cancer, so we have a system called adapted MELD whereby patients with primary liver cancer (around 20% of the total patient candidates) receive extra points in the score. Patients with liver cancer would otherwise receive a lower MELD score. This is a fair system. Overall, patients who need it the most go to the top of the list based on the MELD system.