I don't know if this is a solution for you, but since the lme4 glmer function can provide random intercept posterior median estimates and their conditional variance - and under the assumption of normality (for random effect), posterior median = posterior mode - wouldn't it be valid to do a parametric bootstrap repeatedly drawing from the estimated posterior distribution to obtain a confidence interval for the MOR?
Merlo describes MOR conceptually as the median of all possible pairwise odds ratios (with the larger of the pair in the numerator in all cases) - so
for random intercept posterior estimates on the log scale -
this would be median of:
exp(abs(X(a) - X(b))) for all a,b pairs of clusters.
-- to test this interpretation, in a fitted model I compared this
estimate to what was produced by the approximation based on area variance estimate alone in Merlo (eq 6). I did get very similar results, 1.623 from the median of 1000 bootstrap replicates vs. 1.629 based on the Merlo approximation.
t<- ranef(fit.1,condVar = TRUE)
est<-as.numeric(unlist(t$clientid.x))
var<- as.numeric(unlist(attr(t$clientid.x,"postVar")))
### bootstrap
### create empty output collection:
mor_boot<- c()
#### iterate over replicates
for(i in 1:1000){
### draw vector of area random effects from normal
drw<- rnorm(n = length(est),mean = est,sd = sqrt(var))
### create data frame with all possible pairs
s<- combn(drw,2)
#### estimate MOR and save in output
mor_boot<- c(mor_boot, median(exp(abs(s[1,]- s[2,]))))
}
### bootstrap median and 95% CI
quantile(mor_boot, c(.025,.5,.975))