Reactive care for abdominal organ failure—through costly interventions like liver, kidney, pancreas, and multivisceral transplants—imposes a substantial healthcare burden in the U.S., with first-year costs ranging from $400,000 to over $2 million per case, plus significant long-term expenses and productivity losses. While transplantation improves survival and can be cost-effective (especially kidney vs. dialysis), it remains a late-stage solution. In contrast, preventative care—including chronic disease management, hepatitis C treatment, obesity and alcohol intervention, and early screening—has shown the ability to reduce organ failure incidence, improve patient outcomes, and lower aggregate costs over time. Historical trends reveal that while some successes (e.g., HCV treatment) have reduced transplant demand, preventable causes like diabetes, NASH, and alcohol-related liver disease continue to drive high transplant volumes. Ultimately, a balanced strategy that prioritizes prevention while supporting efficient reactive care offers the greatest opportunity to contain costs and improve outcomes in abdominal transplantation.