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Liver transplantation equity: Supply, demand, and access

Despite advances in treatment for end stage liver disease (ESLD), death from cirrhosis and chronic liver disease remains a major source of morbidity and mortality, particularly in younger patients. The National Center for Health Statistics estimates that the years of life lost prior to age 75 due to ESLD has increased from 164.1 per 100,000 in 2000 to 190.3 in 2015, exceeding life years lost from cerebrovascular disease (161.0), colorectal cancer (123.3), and HIV (50.4).(1) Liver transplantation is the sole treatment for patients with decompensated liver failure, with exceptional success among patients who make it through transplant. Unfortunately, the barriers to transplant are significant, as patients must be referred for transplant evaluation, meet medical and financial eligibility requirements, survive to be allocated one of an insufficient number of donor organs, and maintain their allograft after transplantation. At each step, patients with lower socioeconomic status are known to face greater challenges and have diminished access to transplant. 
 
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