New findings published in the Journal of American College Surgeons suggest that due to several factors, including a lack of private health insurance and a lack of awareness about available options, Black Americans are less likely to be included on liver transplant waiting lists than white Americans.

For the study, researchers reviewed deceased donor liver transplant and waiting list data for 109 high-volume liver transplant centers. Using five-year U.S. Census Bureau estimates from 2017, scientists examined the demographics of each center’s donor service area (the geographic area the center serves).

Altogether, more than 30,000 patients were on the waiting lists. Demographic information showed that individuals were 69% white, 17% Hispanic, 7.9% Black and 6.1% other racial or ethnic groups. However, the national racial/ethnic distribution from the 2017 Census data showed that these centers served patients who were 61.5% white, 17.6% Hispanic, 12.3% Black and 8.6% other racial or ethnic groups.

This contrast showed that 4.4% of Black patients were disproportionately left off liver transplant waiting lists, compared with other racial groups. A greater proportion of white (7.5%) and Hispanic (.6%) patients were put on the waiting lists than those counted in each of these groups according to the national Census data. Only 2.5% of other racial/ethnic groups were left off the waiting lists.

When researchers looked at actual liver transplant surgeries, the disparities shifted slightly. In this case, 70.9% of procedures occurred among whites, 9.4% among Blacks, 14% among Hispanics and 5.7% among other racial/ethnic groups.

Researchers cited myriad reasons—such as access to health insurance, travel distance and lack of knowledge about transplant options on the part of both patients and doctors—for these waiting list disparities.

“When we looked at the characteristics of each individual center that correlated with that difference, we found that the more each center transplanted people with private insurance, the less they were representative of the Black population in their donor service area,” said Ali Zarrinpar, MD, PhD, FACS, a transplant and hepatobiliary surgeon at the University of Florida, Gainesville, and the study’s lead author.