Liver transplantation has undergone significant evolution since its inception, driven by advancements in surgical techniques, immunosuppression, and patient management. Shifts in donor utilization, indications for transplantation, and technological innovations have redefined the field. The introduction of direct-acting antivirals has drastically reduced the need for liver transplantation due to hepatitis C virus-related cirrhosis and hepatocellular carcinoma, transforming the disease into a manageable condition. Non-alcoholic steatohepatitis has emerged as a leading indication for liver transplantation, driven by global obesity and diabetes epidemics, while liver transplants for alcohol-associated liver disease have risen due to changing societal attitudes and expanded eligibility criteria. Living donor liver transplantation has become increasingly utilized, offering a solution to organ shortages with advances in surgical techniques and donor safety protocols. Organs from older donors, those with comorbidities, or marginal grafts are now utilized, supported by improved preservation and perfusion techniques. Donation after circulatory death has contributed significantly to the organ pool, with challenges such as ischemia-reperfusion injury mitigated through normothermic machine perfusion to enhance graft viability.