Geographic disparities in access to liver transplant for advanced cirrhosis: Time to ring the alarm!

Jasmohan S. Bajaj, Ashok Choudhury, Vinay Kumaran, Florence Wong, Wai Kay Seto, Mario Reis Alvares-Da-Silva, Hailemichael Desalgn, Peter C. Hayes, Ramazan Idilman, Mark Topazian, Aldo Torre, Qing Xie, Jacob George, Patrick S. Kamath

Research output: Contribution to journalArticlepeer-review


Decompensated cirrhosis and hepatocellular cancer are major risk factors for mortality worldwide. Liver transplantation (LT), both live-donor LT or deceased-donor LT, are lifesaving, but there are several barriers toward equitable access. These barriers are exacerbated in the setting of critical illness or acute-on-chronic liver failure. Rates of LT vary widely worldwide but are lowest in lower-income countries owing to lack of resources, infrastructure, late disease presentation, and limited donor awareness. A recent experience by the Chronic Liver Disease Evolution and Registry for Events and Decompensation consortium defined these barriers toward LT as critical in determining overall survival in hospitalized cirrhosis patients. A major focus should be on appropriate, affordable, and early cirrhosis and hepatocellular cancer care to prevent the need for LT. Live-donor LT is predominant across Asian countries, whereas deceased-donor LT is more common in Western countries; both approaches have unique challenges that add to the access disparities. There are many challenges toward equitable access but uniform definitions of acute-on-chronic liver failure, improving transplant expertise, enhancing availability of resources and encouraging knowledge between centers, and preventing disease progression are critical to reduce LT disparities.

Original languageEnglish (US)
Pages (from-to)733-742
Number of pages10
JournalAmerican Journal of Transplantation
Issue number5
StatePublished - May 2024


  • ACLF
  • CLEARED consortium
  • World Bank
  • access
  • deceased-donor transplant
  • gender
  • hepatocellular cancer
  • live-donor transplant
  • resources

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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