Living donor liver transplantation (LDLT) has been controversial since its inception. Begun in response to deceased donor organ shortage and waiting list mortality, LDLT was initiated in 1989 in children, grew rapidly after its first general application in adults in the US in 1998, and has declined since 2001. There are significant risks to the living donor, including the risk of death and substantial morbidity, and two highly publicized donor deaths are thought to have contributed to decreased enthusiasm for LDLT. Significant improvements in outcomes have been seen over recent years and data, including from the NIH-funded Adult-to-Adult Living Donor Liver Transplantation Cohort Study, A2ALL, has established a survival benefit from pursuing LDLT. Despite this, LDLT still comprises less than 5% of adult liver transplants, significantly less than in kidney transplantation where living donors comprise approximately 40% of all transplant performed. The ethics, optimal utility and application of LDLT remain to be defined. In addition, most studies to date have focused on post-transplant outcomes and not included the effect of the learning curve on outcome or the potential impact of LDLT on waiting list mortality. Further growth of LDLT will depend on defining the optimal recipient and donor characteristics for this procedure as well as broader acceptance and experience in the public and in transplant centers.