The daily symptom burden in other end-stage chronic organ failure diseases such as advanced congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) are high, with the most frequently reported symptoms being fatigue, dyspnea, insomnia, and pain. When compared with ESLD, the amount and burden of physical symptoms are similar, but those with ESLD report higher levels of mental health functional impairment. It is unclear why patients with ESLD report higher levels of mental health functional impairment. It may be that patients with ESLD have more cognitive impairment from hepatic encephalopathy; more social and family distress associated with the illness; or more comorbid conditions such as substance abuse, depression, and anxiety. Therefore, it is very important that the nurse's assessment encompass both physical, mental health, and social support quality of life components.