The liver transplant system tried to fix its sex bias. Did it work?

In the United States, receiving a liver transplant should depend on the severity of a patient's condition and their likelihood of benefiting from the procedure. However, research has shown that women are more likely to die waiting for a liver transplant and are less likely to receive one compared to men. This disparity is rooted in the Model for End-Stage Liver Disease (MELD), a scoring system used since 2002 to rank patients on the waiting list.

The MELD score considers blood test values, such as creatinine, which is affected by muscle mass. Women generally have lower muscle mass than men, meaning that lower creatinine levels in a woman's blood can make her seem healthier than she is, placing her further down the liver waiting list. In 2023, the liver transplant system introduced MELD 3.0, which aimed to address this sex disparity by adding 1.33 points to women's scores.

This adjustment was meant to account for the difference in creatinine levels between men and women. However, early research indicates that MELD 3.0 has not yet achieved parity between men and women on the liver waiting list. Experts suggest that the problem may lie not just in the scoring system, but also in the fact that smaller patients, who are more often women, have a harder time finding a liver that fits their body size.