Under strict indication criteria (solitary tumor < 5 cm or up to 3 tumors < 3 cm, no vascular invasion) the 5-year-survival rate after liver transplantation for HCC in cirrhosis is up to 70% to 75% in comparison to 80% to 90% in benign disease. With regard to organ shortage an extended indication for liver transplantation in HCC, i.e. for highly differentiated HCC between 5 cm and 7 cm, can only be discussed if there is an increase in the number of donor livers. Currently, living donation offers the only solution for this problem. The decision for living donor liver transplantation for an extended indication has to be drawn most carefully and individually. In addition to the donor's risk, to the prognosis of the recipient and to economical aspects the desire of the donor to offer the chance of transplantation despite a probably poor prognosis has to be considered and respected.