250,000–1,000,000 deaths occur every year due to hepatocellular cancer (HCC) worldwide and HCC is the fifth most common cause among cancer deaths. When diagnosed only 10-30% of HCCs are resectable and even resected 70% of them cannot be cured. Liver Transplantation (LT) offers better survival rates and cure chance for HCC when compared to resection or any other local treatment modalities. Rationale for liver transplantation is the multicentricty of the tumors and the high risk of recurrence after local treatment. LT also cures the underlying chronic liver disease.

Advantages of LT are to provide complete tumor resection, to cure of underlying liver disease and to eradicate liver tissue that may contain occult HCC or dysplastic nodules. Whereas the disadvantages are the surgical risks, organ shortage, long waiting list, higher cost, and lifelong commitment to immunosuppresives.

Live donor LT for HCC has more advantages over LT from deceased donors such as; waiting time is negligible and the surgery is planned, avoids the risk of tumor progression and avoids transplant ineligibility. On the other hand there is considerable risk to the donor which is the main concern in live donor LT.

A debate has been going on for a long time to decide who is going to benefit from transplantation most and efforts have been made to develop inclusion and exclusion criteria for transplantation. Although the initial series without patient selection criteria had dismal results, Milan criteria has increased the survival rates up to 75% for transplantation for HCC and have been applied worldwide. Today selection criteria have been expanded and excellent survival rates are achieved for tumors without major vascular invasion and a total tumor diameter less than 8-10 cm.