OBJECTIVES: Evaluate for the first time in Brazil the pertinence of systematically requesting whole-body bone scintigraphy in early-stage HCC adult patients as a requisite for inclusion on the waiting list for HTx from a deceased donor, according to a reference center in South Brazil.  Current pre-transplantation evaluation policy includes mandatory bone scintigraphy as a requisite for selecting patients to be included on hepatic transplantation list. Previous studies, however, have shown that routine scintigraphy is not cost-effective and generates unnecessary Health System costs. METHODS: We retrospectively analyzed 256 medical files of early-stage HCC patients who underwent hepatic transplantation, 187 of whom were subjected to pre-transplantation bone scintigraphy. The most common etiology was hepatitis C viral infection, the most common liver functional class was Child B, and 78% of the patients met the Milan criteria. None of the 187 scintigraphies was positive for metastasis. The 1- and 5-year post-hepatic transplantation survival rates among patients subjected to bone scintigraphy were 81% and 69%, respectively; those among patients not subjected to scintigraphy were 78% and 62%, respectively (p = 0.25). The 1- and 5-year post-HTx recurrence rates among patients subjected to bone scintigraphy were 4.8% and 10.7%; those among patients not subjected to scintigraphy were 2.9% and 10.1%, respectively (p = 0.46). RESULTS: The cost generated by the current evaluation policies, US$ 27.582, did not result in the detection of any sub-clinical metastasis and therefore failed to provide positive cost-effectiveness. CONCLUSIONS: Clinical evidence has demonstrated that bone scintigraphy did not provide aditional information about patient selection since the incidence of metastasis in early stages is very low.  In our cohort, the use of scintigraphy in the assessment of patients with early stages of HCC and within the Milão criteria, included in a liver transplant list by dead donor, in a center in the south of Brazil, had  zero benefit.