Approaching horizontal equity in liver transplant from a racial and ethnic perspective
I recently read the article, “Selection of patients with hepatocellular cancer: a difficult balancing between equity, utility, and benefit” by Alessandro Vitale and Quirino Lai, published in Translational Gastroenterology and Hepatology (2017;2:75) (1). I think that the authors succeeded in their goal of identifying a fair window for determining transplant benefit for patients with hepatocellular carcinoma and nonmalignant liver diseases; they balance utility and urgency in a way that I feel is fitting for end-stage liver disease. However, I would like to expand on their assessment of equity within transplant. In this work, the authors consider equity within transplant as it relates to vertical equity between patients with different levels of disease progression, as well as horizontal equity between patients with and without liver cancer. While these authors established a good theoretical framework for horizontal equity, I think that when applying it to reality, this principle needs to be broken down to better represent certain populations dealing with disparate access to liver transplant.