Sundaram V, et al. - In view of the fact that patients listed as status-1a for liver transplantation (LT) are currently receiving the highest priority on the waiting list, researchers used competing risks regression to evaluate waitlist mortality risk. The presence of acute on chronic liver failure with three or more organs failing (ACLF-3) predicts low survival without transplantation, which might not be reflected by the model for end-stage liver disease-sodium (MELD-Na) score. For patients listed status-1a and those with ACLF-3 at listing, short-term waitlist mortality was compared. At the time of listing, patients with ACLF-3 have 14-day mortality higher than those listed as status-1a, regardless of MELD-Na score. These outcomes reveal the importance of early transplant assessment and transplant priority consideration for ACLF-3 patients.