Liver-allocation policies for patients affected by HCC in Europe

The main goal of organ-allocation systems is to guarantee equal access to the limited resource of liver grafts for every patient on the waiting list, striking a balance between the ethical principles of equity, utility, benefit, need, and fairness. The European healthcare scenario is very complex, as it is essentially decentralized, and each nation—and region inside the nation—operates with a significant degree of autonomy. Furthermore, the epidemiology of liver diseases and hepatocarcinoma (HCC) differs between European countries and clearly affects indications and priorities. The aims of this review were to analyze the liver-allocation policies for HCC in different European countries. The European area considered for this analysis included five macro-areas or countries with similar liver-sharing and allocation policies: 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 français des Greffes (EfG) in France; NHS Blood & Transplant (NHSBT) in the UK and Ireland; and Scandiatransplant (Sweden, Norway, Finland, Denmark, and Iceland). Each area identified as a network for organ sharing in Europe adopts an allocation system based on either a center-oriented or a patient-oriented policy. Worldwide, two primary principles dominate the priorization of patients with HCC on the waiting list for deceased-donor liver transplant: urgency and utility. Although no common organ-allocation policy for European countries exists, long-term survival rates for patients with HCC on the transplant waiting lists are comparable to those reported in the United Network for Organ Sharing (UNOS) register. However, as allocation principles are discussed, new proposals emerge, and the epidemiology of liver disease changes, we strongly recommend steps are taken toward a common system.