Racial Disparity in Liver Transplantation Listing

Background Previous studies have demonstrated disparities in transplantation for women, non-Caucasians, the uninsured or publicly insured, and rural populations. We sought to correlate transplant center characteristics with patient access to the waiting list and liver transplantation. Hypothesis Liver transplant centers vary greatly in providing equitable access to the waiting list and liver transplantation. Study Design Center-specific adult deceased donor liver transplant and waitlist data for the years 2013 to 2018 were obtained from the Scientific Registry of Transplant Recipients. Waitlist race/ethnicity distributions from liver transplant centers performing ≥250 transplants over this period (n=109) were compared with those of their Donor Service Area, as calculated from 5-year US Census Bureau estimates of 2017. Center-specific characteristics correlated with disparities were analyzed using a linear regression model with a log transformed outcome. Results Non-Hispanic Blacks (NHBs) are underrepresented in liver transplant listing compared to center Donation Service Area (88/109, 81%), whereas non-Hispanic Whites are overrepresented (65/109, 58%) (p Conclusions Non-Hispanic Blacks are listed for liver transplantation less than would be expected. Once listed, however, racial disparities in transplantation are greatly diminished. Improvements in access to adequate health insurance appears to be essential to diminishing disparities in access to this life-saving care.