Liver transplantation for hepatocellular carcinoma is a controversial and oft debated issue. The debate revolves around utility i.e. expected gain to the recipient of the liver graft in terms of survival after transplantation as opposed to the same graft being offered to someone without a tumor and equipoise i.e. whether the risk of transplant and its aftermath is lower than the risk of other therapies. In Asian countries and India since a living donor graft is the most common liver graft used, there is a double equipoise to be satisfied. Not only does the patient require to have a good expectation of survival but the advantage to the patients has to be significant enough to justify the risk albeit minimal to the living donor. How to select such patients before transplant remains an area of great interest and investigation. This and other issues have been addressed in my article based on my experience and the current published literature on the subject.
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