Native Americans are much less likely than other racial groups to gain a spot on the US national liver transplant list, despite having the highest rate of death from liver disease.

According to an analysis of four years of transplant data by The Markup and The Washington Post, for every 100 deaths from liver disease, only 9 Native American patients are accepted for transplant listing, the lowest rate among all racial groups studied. 

Native Americans are four times more likely to die from the disease than non-Hispanic White people, according to the US Department of Health and Human Services. It is the second leading cause of death among Indigenous men ages 35 to 44. 

With native Americans advancing to surgery at the same rate as White people, the study showed that access to the live transplant list is a primary driver of disparity, with white people gaining a spot on the transplant list almost three times more often than Native Americans.

However, experts said native Americans may not know that a liver transplant is an option, resulting in large numbers of Native Americans with liver problems dying untreated.