The timing of liver transplantation and the predictive factors have been reviewed as well as criteria systems for evaluation of the survival are discussed. Liver transplantation is the only treatment for patients with end-stage liver disease. Yet, it is emphasized, that the preoperative condition of the patient plays a crucial role in the final outcome after transplant. The early referral is one of the most important keys to the success of transplantation. Offering liver transplantation before patients have deteriorated to the point of needing intensive care unit support, may lead to decreased morbidity and ultimately improve the overall survival rate of this challenging procedure.