Orthotopic liver transplantation (OLT) has evolved in China over three decades, emerging as the mainstay treatment for hepatocellular carcinoma (HCC). Some Chinese transplantation centers have begun offering OLT for selected patients with HCC exceeding Milan criteria. However, this still remains a controversial subject. In this article, we have weighed arguments for and against OLT for advanced HCC. Meanwhile, the development of OLT for HCC in China has raised problems, mainly focused on ethical and moral concerns. Postmodern philosophy and ethics, particularly the life value theory, shall be the theoretical support to the concept of abandoning treatment. In China, ethical selection for OLT and abandoning treatment for HCC must be made justly and prudently.
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