Liver transplantation (LT) is the only curative option for most patients with decompensated cirrhosis. Indications for LT have been fairly well established over the years, but are no clear-cut guidelines on contraindications. The dynamic nature of complications in patients with liver disease in a given time point may influence the decision for LT, depending on disease severity in the recipient and on the expertise in the liver unit. Associated metabolic and cardiovascular comorbidities may also influence candidacy for liver transplantation in patients with Metabolic associated steatotic liver disease (MASH) cirrhosis. Likewise, duration of alcohol abstinence and severity of alcohol-related liver disease influence timing of liver transplantation. Severity of portopulmonary hypertension may be a contraindication for LT. Active sepsis and untreated acquired immunodeficiency syndrome are absolute contraindications for LT. Sarcopenia and frailty should be improved as much as possible, prior to the surgery. Acute-on-chronic liver failure (ACLF) is an increasing indication for LT. Patients with ACLF-3 should preferably be treated and the disease severity downgraded before being considered for LT. Despite expanding criteria for LT in hepatocellular carcinoma, patients with macrovascular invasion and extrahepatic disease are contraindicated from LT. A multidisciplinary team approach should be carried out in the decision for LT. If contraindicated, and in case of relative contraindication, the reason should be clearly documented. Revisiting the case at a later date with discussion between the patient and their family members and members of the transplant team is encouraged.