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The Model for End-Stage Liver Disease (MELD) scoring system was originally used to estimate 3-month survival after elective transjugular intrahepatic portosystemic shunt placement. In an effort to more objectively allocate organs, MELD was adopted to determine priority for organ placement for patients with end-stage liver disease. Prior to the MELD-based system, allocation was based on time on the waiting list as well as the Child-Turcotte Pugh scoring system, which used more subjective measurements of liver disease such as degree of encephalopathy and ascites. This created an incentive to list patients earlier with organs being placed in less sick individuals. The MELD score takes into account serum bilirubin, the international normalized ratio (INR) and serum creatinine. Coexistent renal disease (whether hepatorenal syndrome or renal failure as a result of liver failure) is more heavily weighted in the MELD score. Additionally, MELD exception points have been assigned to patients who have more severe liver disease that may not be reflected in the basic MELD score including sodium, hepatopulmonary syndrome and hepatocellular carcinoma. MELD= 3.78xln[serum bilirubin (mg/dL)] + 11.2xln(INR) + 9.57xln[serum creatinine(mg/dL)] + 6.43