In this manuscript the authors examined the impact of MELD exception points. This is mostly commonly given to patients with hepatocellular carcinoma (HCC) who are on the waiting list. Liver transplantation for HCC continues to rise and in some centers approaches 30% of the waiting list. By awarding exception points, patients who are listed with non-HCC indications may be disadvantaged. This article addresses some of these issues. It finds that the rate of exceptions is increasing over time, and varies across regions. Patients who received exceptions are less likely to leave the waiting list, and more likely to be transplanted.