Organ access continues to evolve and is a primary challenge in caring for patients with chronic liver disease. Liver transplant indications in adults have changed over the past decade with the rise of MASLD and the decline of hepatitis C. The landscape of organ availability has concurrently shifted, including national policies, expansion of donor criteria, machine perfusion, and living donor transplant. To highlight the role of living donor transplant in this evolving context, this academic debate session features teams of hepatology trainees and practicing hepatologist debating the pros and cons of the question: Is there a role for living donor liver transplant in adult patients in the age of machine perfusion? The pro position argues that living donor transplant is effective and relevant; the con position argues that living donor transplant will no longer be needed. Debaters, judges, and attendees grapple with opposing scientific, societal, individual, and financial viewpoints on this timely issue.