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As the inpatient consult attending, you have been following a 72‐year‐old man with NASH cirrhosis and multiple medical comorbidities who was transferred to your hospital to manage an esophageal variceal bleed.
This is his fourth hospital admission for complications of his liver disease over the past 6 months.
After his endoscopy, he has remained intubated in the intensive care unit and is now in progressive septic shock and multiorgan system failure with a MELD‐Na score of 37.
The critical care team is planning a family meeting, and the family asks for the hepatology team to be present to discuss his eligibility for liver transplantation.
Despite his grim prognosis, during the meeting, it becomes clear that the family wants “everything done,” including resuscitation if needed.
His wife states “He has always recovered each time he has been hospitalized. He will get through this just like the last time he was here. We are not giving up hope for a miracle.”
When you share that he is not a transplant candidate, his wife becomes distressed and tearful and expresses that he is being denied care because of their racial background.