To the Editor The infeasibility of a randomized clinical trial comparing the survival rate between living donor liver transplant (LDLT) and deceased donor liver transplant (DDLT) is cut-and-dried for understandable ethical concerns. In JAMA Surgery, Lai and colleagues1 ingeniously designed a multicenter cohort study to interrogate the prognostic advantage of patients with hepatocellular carcinoma receiving LDLT with an intention-to-treat (ITT) basis. Results showed that patients undergoing LDLT could potentially experience a decrease of ITT death risk by 33% to 49%. While we applaud the encouraging findings, some issues need to be addressed.