Advocacy for Equity in Transplantation Access for Alcohol-Associated Liver Disease: How Research Changed Medi-Cal Policy

Abstract

Alcohol is the third most common preventable cause of death, and alcohol-associated liver disease (ALD) accounts for 50% of global liver-related deaths.1 Liver transplantation (LT) is the only definitive therapy for end-stage liver disease, but patients with ALD have long been under-represented in access to transplantation.1 A main barrier to transplantation access has been differing requirements of pre-transplantation alcohol abstinence for transplantation eligibility.2 Whereas private insurers typically defer to multi-disciplinary transplant teams for eligibility and alcohol use risk assessment, the majority of Medicaid programs, which cumulatively provide health insurance for 75 million Americans, have additional state-specific requirements for financial reimbursement of transplantation based on longstanding abstinence policies.