BACKGROUND: In patients with hepatocellular carcinoma (HCC), bone metastasis occurs rarely in the natural disease course. 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. 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. 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. RESULTS: 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). CONCLUSIONS: 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.