Validation of the Model of End-Stage Liver Disease for Liver Transplant Allocation in Alberta: Implications for Future Directions in Canada

Table 5

Survey of MELD use in Canada (October 2014).

	BC	AB	ON	PQ	ATL
System	MELD and CanWAIT	MELD 20 and CanWAIT	MELD → MELD-Na	MELD-Na	MELD → Refit MELD-Na
Adopted	2006	JUL 2004	2006 → NOV 2012	JUL 2008	2006 → 2012
Criteria for HCC	Milan; (UCSF)	TTV115 + AFP400	TTV115 + AFP400; or UCSF	Milan	Milan; (UCSF)
HCC Exemptions	MELD 15; + 10% q3m	MELD 22; + 2 pts q3m	MELD-Na 22; + 3 pts q3m	PQ-HCC-MELD; q3m	Refit MELD-Na 22
Other Exemptions	None	HPS, PPHT, Cholangitis, and others	HPS, FAP, HB, 1°HO, CF, metabolic, CCA, Failed LDLT or DCD	Cholangitis, HE, HPS, HEHE, and others	Cholangitis, PCLKD, and others

Abbreviations: BC, British Columbia; AB, Alberta; ON, Ontario; PQ, Quebec; ATL, Atlantic Canada; MELD, model of end-stage liver disease; MELD-Na, MELD-sodium; UCSF, University of California San Francisco; TTV115, total tumour volume ≤ 115 cm³; AFP400, alpha-fetoprotein ≤ 400 ng/mL; q3m, every three months; HPS, hepatopulmonary syndrome; PPHT, porto-pulmonary hypertension; FAP, familial amyloidosis polyneuropathy; 1°HO, primary hyperoxyluria; CF, cystic fibrosis; CCA, cholangiocarcinoma; LDLT, live donor liver transplantation; HE, hepatic encephalopathy; HEHE, hepatic epitheliod hemangioendothelioma; PCLKD, polycystic liver and kidney disease.
MELD 20 policy (July 2004–December 2014) = Patients waiting at home (status 1) with a MELD ≥ 20 were given priority; however, hospitalized patients (status 2) with a lower MELD score would still receive an organ first.