Purpose: Living donor liver transplantation (LDLT) is an alternative to deceased donor transplantation (DDLT), and can mitigate the risk of dying while waiting for transplant. While evidence exists of differential access to living donor kidney transplants, little is known about access to LDLT among racial/ethnic minorities.

Methods: Using United Network for Organ Sharing (UNOS) data of all adult liver transplant recipients at LDLT-capable centers from 2/27/2002 – 6/4/2014, we analyzed primary outcome of LDLT based on race/ethnicity. Using data from two urban transplant centers of all potential living donors who inquired about liver donation in the past 5 years, we assessed success of donation/reasons for exclusion based on racial/ethnic category.

Results: Of 35,401 total liver transplant recipients, 2,171 (6.1%) received an LDLT. Among LDLT recipients, 3.5%, 9.7%, and 2.7% were black, Hispanic, and Asian, respectively, compared to 9.1%, 13.8%, and 4.9% of DDLT recipients, respectively. Disparities persisted in multivariable models, regardless of hepatic pathology:

Data from two transplant centers demonstrated not only that black patients were less likely to have a potential donor inquire about donation, but also that among patients who did receive at least one inquiry, white patients had an average of two times as many potential donors as black patients. Hispanic patients showed a similar trend.

Conclusions: Racial/ethnic minorities receive a disproportionately low percentage of LDLTs, due in part to fewer initial inquiries by potential donors. This represents a major inequality in access to a vital healthcare resource and demands outreach to both patients and potential donors.

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