Striving towards equity in liver transplantation

“Unfortunately, there are more patients in need of liver transplantation than there are available donors. This leads to long wait times and the risk of patients becoming too sick to receive a liver transplant,” says transplant hepatologist Danielle M. Tholey, MD. In fact, 15% to 20% of patients who are on waiting lists to receive liver transplants end up dying before being able to receive them. Disproportionately more white males receive liver transplants in the U.S., while women of all races often die waiting to receive a transplant. 

In their recent study, Dr. Tholey and her team at Thomas Jefferson University wanted to identify why men seem to be receiving more liver transplants than women. They looked at race, sex, insurance and education of patients receiving liver transplants. They then grouped the patients by whether they received a liver transplant from a deceased donor or a living donor.

Studies have shown that patients who receive a liver from a living donor have a quicker recovery post-procedure and longer survival rates. The researchers found that liver transplants from deceased donors were more likely to be received by male patients, regardless of race. However, the sex disparities were attenuated in living donor liver transplantation (55% men vs. 45% women compared to 67% men vs. 33% women for deceased donation). Surprisingly, liver donations from living donors were most likely to be received by Black and Hispanic women than men, making the sex disparity less pronounced. Overall, women are disadvantaged in receiving transplants, but there are no definitive answers as to why this is, although it is an active area of study.

In addition, the study addressed liver donor demographics. Importantly and interestingly, live donors were more likely to be women than men.

“Patients are less familiar with living donor transplants so sadly, they make up a small number of transplants in the U.S., despite offering superior outcomes,” says Dr. Tholey, “Further, living donor transplants may help alleviate the sex disparities based on our data.” She adds that resources such as Donor Shield can help alleviate financial burdens that could deter patients from living donor transplants by providing financial support to assist with medical costs, missed work or legal support affiliated with being a living donor, so they simply can focus on helping to save someone’s life.

“Studies like these shine light on the persistent disparities in health care, and encouragement of living donor transplantation is one small step towards alleviating some of these disparities,” says Dr. Tholey.

By Moriah Cunningham