Liver Transplantation Wait Times Differ Between Races/Ethnicities

In states that expanded Medicaid, patients with hepatitis C virus (HCV) who are Black receive quicker liver transplantations, according to a new analysis. However, patients who are Hispanic and do not have HCV are waiting longer for liver transplantations.

“In 2014, the Affordable Care Act (ACA) sought to expand insurance coverage through an optional state-level expansion of Medicaid,” the researchers wrote. “After the main ACA provisions went into effect in 2014, the percentage of adults who were uninsured decreased by 7.1% for Hispanic patients, 5.1% for Black patients, and 3% for White patients.”

For their cohort study, the researchers used data from United Network of Organ Sharing database on adults who were waitlisted for liver transplantation between January 1, 2010, and December 31, 2017 (N=75,748).

The researchers then compared the waitlist rates by race/ethnicity in states that expanded Medicaid with those that did not expand Medicaid. Then, they compared the waitlist rates of actual vs predicted liver transplantation by race/ethnicity after the expansion.

Results showed that in states that expanded Medicaid, patients who are Black or Hispanic were statistically significantly more likely to be waitlisted compared with states that did not expand Medicaid.

“After Medicaid expansion, there was a decrease in the wait-listing rate of Black patients in expansion states but not in nonexpansion states,” the researchers wrote. “This decrease was not seen when Black patients with [HCV] were excluded from the analysis, suggesting that they may be responsible for this expansion state trend.”

Moreover, patients who are Hispanic and had Medicaid but did not have HCV were statistically more likely to be waitlisted after the Medicaid expansion than predicted pre-expansion.

—Amanda Balbi


Nephew LD, Mosesso K, Desai A, et al. Association of state Medicaid expansion with racial/ethnic disparities in liver transplant wait-listing in the United States. JAMA Netw Open. Published online October 8, 2020.