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Curr Transplant Rep. 2016 Dec;3(4):313-318. doi: 10.1007/s40472-016-0117-6. Epub 2016 Oct 7.

Liver-allocation policies for patients affected by HCC in Europe.

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International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy.
Department of Surgical Sciences, University of Pavia, Italy.
Liver Center, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.


The main goal of organ allocation systems is to guarantee an equal access to the limited resource of liver grafts for every patients on the waiting list, balancing between the ethical principles of equity, utility, benefit, need, and fairness. The European heath care scenario is very complex, as it is essentially decentralized and each Nation and Regions inside the nation, operate on a significant degree of autonomy. Furthermore the epidemiology of liver diseases and HCC, which is different among European countries, clearly inpacts on indications and priorities. The aims of this review are to analyze liver allocation policies for hepatocellular carcinoma, among different European. The European area considered for this analysis included 5 macro-areas or countries, which have similar policies for liver sharing and allocation: Centro Nazionale Trapianti (CNT) in Italy; Eurotransplant (Germany, the Netherlands, Belgium, Luxembourg, Austria, Hungary, Slovenia, and Croatia); Organizacion Nacional de Transplantes (ONT) in Spain; Etablissement fran├žais des Greffes (EfG) in France; NHS Blood & Transplant (NHSBT) in the United Kingdom and Ireland; Scandiatransplant (Sweden, Norway, Finland, Denmark, and Iceland). Each identified area, as network for organ sharing in Europe, adopts an allocation system based either on a policy center oriented or on a policy patient oriented. Priorization of patients affected by HCC in the waiting list for deceased donors liver transplant worldwide is dominated by 2 main principles: urgency and utility. Despite the absence of a common organs allocation policy over the Eurpean countries, long-term survival patients listed for transplant due to HCC are comparable to the long-term survival reported in the UNOS register. However, as the principles of allocation are being re-discussed and new proposals emerge, and the epidemiology of liver disease changes, an effort toward a common system is highly advisable.


Europe; Hepatocellular Carcinoma; allocation policy; liver transplantation

Conflict of interest statement

Conflict of Interest Mario Strazzabosco, Stefano Okolicsanyi, Vincenzo Buscemi, Leonardo Centonze, Luciano De Carlis, Riccardo De Carlis, Stefano Di Sandro, Fabio Ferla, Andrea Lauterio, Raffaella Sguinzi, and Luca Saverio Belli declare no conflict of interest. MS has received speaking honoraria from Bayer, None of the other authors have any conflict of interest, neither in terms of funding or of commercial associations.

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