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May 20, 2020

Time for Action to Address the Persistent Sex-Based Disparity in Liver Transplant Access

Author Affiliations
  • 1Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, New York
  • 2Department of Medicine, Division of Gastroenterology & Hepatology, University of California San Francisco, San Francisco
JAMA Surg. Published online May 20, 2020. doi:10.1001/jamasurg.2020.1126

In 2018, women on the liver transplant waiting list experienced an 11% decreased rate of deceased donor liver transplant than men.1 It has been known for more than a decade that women are disadvantaged on the liver transplant waiting list, with an increased risk of death and a decreased probability of deceased donor liver transplant compared with men.2 While there is evidence of broader disparities in liver-related health care for women, including lower likelihood of referral for liver transplant evaluation as well as being listed for transplant once referred, there are aspects of the current allocation system that unintentionally disadvantage women but that are purely dictated by policy and are feasible to address. Despite this knowledge, there has been no effective national push to implement evidence-based systematic changes and thus no improvement in waiting list outcomes for women (Figure).

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