Model for End Stage Liver Disease and hepatocellular carcinoma: a moving target.

The institution of the Model for End Stage Liver Disease (MELD) score has been a successful refinement to the allocation for cadaveric liver allografts. Likewise, transplantation for patients with hepatocellular carcinoma (HCC) within defined criteria (Milan) has been shown to be very efficacious. The placement of patients with HCC in the allocation scheme with a MELD exception score has been an ongoing process of adjustments. The most recent data would suggest that patients with HCC continue to benefit from enhanced access to transplantation compared with patients without HCC. Development of a continuous HCC score, similar to the MELD score, maybe a more consistent and impartial way to equate access to cadaveric liver allografts for candidates with HCC and those without HCC.