Successful human liver transplantation started, after a stuttering start, in 1967, led by the pioneering work of Thomas Starzl and others, such as Roy Calne, Rudolph Pichlmayr, Henri Bismuth, and Ruud Krom, supported by other health care professionals and scientists. The NIH Consensus Conference in 1983 marked the establishment of liver transplantation as a valid therapeutic option. Since that time, the number of liver transplants and transplant units has increased around the world, and outcomes have improved dramatically. Over the six subsequent decades, transplantation has evolved with many surgical advances, allowing donation from deceased and living donors, and use of liver segments and lobes and spliting livers to allow two recipients to receive a graft from one donor; Indications have evolved, and currently, alcohol-related liver disease and metabolic-dysfunction associated liver disease are the commonest indications. Immunosuppression has evolved from the early days using just prednisolone and azathioprine, sometimes with induction with anti-T cell induction, to triple therapy, most frequently using tacrolimus, mycophenolate, and prednisolone, although other drugs are also available to ensure optimal immunosuppression. As outcomes have improved, graft failure from acute or chronic (ductopenic) rejection, technical (often biliary) issues, and hemorrhage have become rare, and major causes of premature graft and patient loss are more related to recurrence of disease, cardiovascular and renal disease, and de novo malignancy. To support liver transplantation, jurisdictions and international and national professional bodies have developed laws, regulations, policies, and procedures to ensure that organ donation and transplantation are carried out in a controlled way under clear ethical and legal frameworks. Improvements in the outcomes after liver transplantation cannot be attributed to any one factor but occur as a result of the teamwork of many health care professionals and scientists. Issues still remain: relative organ shortage and potential shortage of skilled surgeons are of concern. In contrast, the use of machine perfusion is likely to improve outcomes and increase organ utilization. The place of xenotransplantation and other modalities is yet to be determined.