A growing demand for liver transplantation coupled with a static supply of organs results in an excess demand crisis. Excess demand for liver transplantation equals the number of patients left on the UNOS waiting list at the end of the year who have not expired, undergone transplant, or been withdrawn. Only in the arena of transplantation doses the United States medical community confront a true rationing dilemma stemming from a scarcity of livers available for transplantation. An excess demand crisis intensifies debate in policy areas such as allocation and patient listing criteria. A cohesive rationing policy should manage both the demand for transplantation and the supply of transplantable organs. Demand-side management as applied to liver transplantation could decrease the incidence of critically ill patients waiting for transplants, the number of retransplants performed and the total cost of transplantation to the health care system.