It sounds like your brother by definition is already a Childs B if he has ascites and likely has varices if the doc is recommending a TIPSS. He needs to be at a transplant center before anything else is done at all. The advocate is correct about MELD score, but this is clearly decompensated cirrhosis and needs to be seen at a center where he can be evaluated for transplant. You are slightly old for live donor, by the way. Good luck to both of you! DTD
If your brother has ascites (which I am assuming since they want to do a TIPS) and encephalopathy he is not grade A - he is grade B or C. But more important, for transplant purposes we now use the MELD score (ask his doctor what the MELD score is). The A,B,C score is the Child Pugh Score. I suggest your brother gets a second opinion from a hepatologist at a transplant center.