While every transplant program designs its own evaluation protocols, in every case the evaluation includes: an assessment of need for transplant; the presence of competing conditions that would likely impair recovery after transplant; and patient wishes. Urgency for transplantation is determined primarily by the Model for End-Stage Liver Disease (MELD) score, albeit with numerous exceptions to the MELD score. Contraindications to transplantation can be divided into those that increase the likelihood of perioperative mortality and those that present a competing risk for death even if the transplant is successful. Each transplant center designs its own evaluation process, but there are many elements that are common to all. The first step for the ambulatory patient is a clinic visit with the transplant hepatologist for an initial assessment. The next step is testing. The final step is discussion in a multidisciplinary liver transplant selection committee.