Liver Allocation Paradox and HCC Priority

Trenches in Transplant Surgery · Oct 12, 2026 · 47m

Liver transplantation for hepatocellular carcinoma (HCC) requires balancing tumor biology, medical urgency, and waitlist equity, as standard Model for End-Stage Liver Disease (MELD) scores often fail to capture cancer progression risks. Recent policy shifts, such as the adoption of MMaT-3 and donor-hospital exception frameworks, have successfully equalized transplant rates between cancer and non-cancer candidates while reducing overall waitlist mortality, though they have simultaneously lengthened waiting times and increased relative dropout for patients with HCC. To address this ongoing…