Purpose of Review <p>Living donor liver transplantation (LDLT) has undergone significant growth throughout the last decade in North America, though it remains underutilized compared to international benchmarks. In this article we sought to describe the current state of LDLT in North America, as well as how practices in both donor and recipient selection are evolving.</p> Recent Findings <p>Most North American LDLT cases are clustered at few high volume, high performing centers, which have established excellent recipient outcomes and low donor morbidity. Strategies to increase donor conversion include pre-operative weight loss for donors with steatosis, establishment of anonymous donation programs, and implementation of minimally invasive hepatectomy techniques. On the recipient side, growing indications include complex candidates with higher MELD scores or undergoing retransplant, in addition to primary and secondary liver cancers. ABO incompatible pairings can be further utilized through living donor paired exchanges or recipient desensitization.</p> Summary <p>Opportunity for expansion of LDLT exists within North America, with best practices drawn from international efforts and early North American adopters. While barriers to implementation exist, LDLT provides timely access to liver transplantation for appropriate candidates, as well as augmentation of the donor organ pool to maximize transplant availability for the greatest number of patients.</p>