Optimal results of hepatic resection for hepatocellular carcinoma are achieved when the tumor is solitary, liver function is normal, and there is no portal hypertension. Patients with single tumors between 2 and 5 cm are eligible for priority on the transplant waiting list, but for those with normal liver function and no portal hypertension overall survival after resection or transplant is similar. While tumor-specific death is less after transplant, there is effective treatment for tumor recurrence, and transplant is associated with an array of complications that can lead to nontumor-related death. Donor organ availability varies regionally but in most locales patients must wait, raising the possibility of drop-out due to tumor progression. The benefit of transplant over resection in appropriate resection candidates is minimal compared to the benefit transplant provided to patients with end-stage liver disease; recognizing this, the US allocation system has progressively lowered the priority accorded to tumor patients. For patients with solitary tumor >2 cm, normal liver function, and no portal hypertension, resection is the treatment of choice whether or not the tumor is within Milan criteria.