All patients needing liver transplantation should undergo a detailed fitness evaluation to assess the benefit and risk of the procedure. Transplant evaluation should focus on conditions that may have the potential to derail intraoperative or postoperative course, enable a formal risk–benefit analysis and tailor intraoperative and postoperative management to a specific patient. A protocolized assessment for liver transplantation should be followed. This includes a comprehensive medical history and physical examination, investigation for medical comorbidities and assessment of recipient’s functional status along with preoperative imaging. Detailed preoperative cardiopulmonary evaluation is needed given the increasing prevalence of metabolic dysfunction-associated steatohepatitis and associated metabolic comorbidities. Upon completion of transplant evaluation, each patient should be discussed in a multidisciplinary transplant meeting to confirm suitability and document perioperative strategies. Living donor liver transplantation offers an advantage of better planning and timing of surgery following patient optimization.