Rates of liver-related mortality (LRM) in the USA surged by 19.1% from 2018 to 2021, with substantial state-by-state differences, underscoring the urgent need for equitable access to liver transplants across the United States, researchers report. This increase has highlighted that access to liver transplantation remains highly variable depending on location, with policy reforms not fully addressing the disparity.
A research team at the University of Chicago’s Division of Gastroenterology and Hepatology, and colleagues noted that while organ allocation policies have helped reduce geographic discrepancies in access, they do not address a crucial barrier: access to transplant centres. “The fair distribution of solid organs continues to be a significant challenge,” they wrote, pointing out the difficulty policymakers face in prioritising transplants for the most critically ill patients while maintaining equity.
Liver-related mortality rates climbed from 77,282 deaths in 2018 (23.6 per 100,000 individuals) to 93,418 in 2021 (28.1 per 100,000 individuals). The disparity in LRM rates was stark, ranging more than fourfold between states in 2021; Utah recorded 18.4 deaths per 100,000 people per year, while New Mexico’s rate was 65.9 per 100,000.
States with the highest LRM rates were found to have significantly fewer in-state donor transplants compared to states with the lowest LRM rates (13% vs. 35.2%). Additionally, states with the highest proportion of in-state transplants showed markedly lower mean LRM than those with the fewest in-state transplants.
Notably, 10 states in the study lacked liver transplant centres, 60% of which were among those with the highest LRM rates. This trend highlights a significant gap in healthcare infrastructure that organ allocation policies alone cannot bridge.
“Liver transplant rates are paradoxically lowest among residents living in states with the highest LRM,” the authors concluded. They urged for “new strategies to ensure fair and balanced access to liver transplants,” regardless of patients’ locations, calling for action to address the critical need for equitable healthcare resources.
Victoria Antoniou, EMJ
Reference
Rinella NS et al. Current Burden of and Geographic Disparities in Liver Mortality and Access to Liver Transplant. JAMA Netw Open. 2024;7(10):e2439846.
