A liver transplant is recommended in two major indications:

1. First being a severe irreversible hepatic failure (connected with the liver) when all known medical or surgical treatment options have been used and there are no known contraindications to the procedure.
2. The second indication is early-stage primary liver cancer where other treatment modalities cannot be used.

A liver transplant is reserved for those patients with a poorer quality of life and higher mortality without a transplant. Liver cirrhosis is the commonest cause of irreversible hepatic failure. Patients with liver cirrhosis who are experiencing or have experienced life-threatening complications such as hepatic coma, refractory variceal bleed, bacterial peritonitis, refractory ascites, or have an unacceptable quality of life are candidates for a liver transplant. The common causes of liver cirrhosis are alcohol, hepatitis B and C, non-alcoholic steatohepatitis (a type of fatty liver disease), and autoimmune diseases. In the pediatric age group, metabolic liver disease like Wilsons' disease and congenital disorders like extrahepatic biliary atresia are important causes of liver cirrhosis needing a liver transplant. There are cholestatic liver diseases like primary sclerosing cholangitis and primary biliary cholangitis which cause intense pruritus along with other features of chronic liver disease. Severe pruritus refractory to any form of treatment is also an indication for a liver transplant. Acute liver failure is an important cause of irreversible liver failure often needing a liver transplant. Common causes of acute liver failure are viral hepatitis A, E, and B. Contraindications to liver transplant include advanced cardiopulmonary disease, the extrahepatic spread of liver cancer, irreversible brain damage and active substance abuse are some of the important causes.