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 français 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.