Orthotopic liver transplantation (OLT) is a highly effective therapy for end-stage liver disease. However, this is a highly complicated and expensive procedure that puts much pressure on the health system in developing countries. We report OLT cost in a new established transplant program in Tehran, Iran. Cost information was obtained from the records in the liver transplant clinic and hospital bills. All data regarding the cost of being in waiting list, hospitalization, donor and recipient procedures, post-operative care and immunosuppression up to 1 year following OLT were included. All costs were converted into US dollars (1 USD = 9000 Rials). The total cost of OLT was about $55555. Of this, 2% was related to the cost in waiting list, 10% to the organ procurement, 2% to the recipient procedure, 6% to the hospitalization, 34% to the medical staffs, 2% to the follow-up care up to 1 year, 40% to the specific drugs including immunosuppressive therapy up to 1 year, and 4% to others including accommodations. The cost of OLT in Iran is about one third of its cost in western countries. The health system also pays for most of the expenses. These, along with full medical insurance coverage of immunosuppressive drugs, make OLT more available for patients regardless of the socioeconomic status. It is expected that a higher number of patients with low socioeconomic status will be candidate for OLT.