Kanwal F, Hernaez R, Liu Y, et al. - Organ scarcity means few individuals with advanced liver disease undergo a transplant. Researchers herein investigated the other common failures in the transplantation process that further impede access to liver transplantation. Using linked data from comprehensive electronic medical records and the United Network of Organ Sharing, they conducted a national-level cohort study of 34,494 patients with cirrhosis. Among these patients, few were referred for, placed on a waiting list for, or received a liver allograft within 3 years of meeting clinical criteria for transplantation, and deficits mostly occurred at the earlier referral step. Findings revealed association of age, comorbidity, and social determinants with low referral, wait-listing, and transplant rates; when documented, most of the gaps in referral were explained by medical and psychosocial barriers. Per these findings, separate benchmarks for referral and wait-listing and interventions that target potentially modifiable barriers may have a correlation with enhanced access to organ transplants.