Domino liver transplantation is a unique and innovative surgical strategy designed to expand the donor organ pool by utilizing the explanted liver from a patient with a non-cirrhotic metabolic liver disease—such as familial amyloid polyneuropathy or maple syrup urine disease—as a graft for a second recipient. While the donor liver carries a genetic or enzymatic defect, it remains structurally and functionally normal, and the recipient is carefully selected to minimize the risk or impact of the transmitted condition. Since its introduction in the mid-1990s, this technique has demonstrated excellent outcomes with comparable graft and patient survival to standard liver transplantation, particularly when meticulous surgical planning, appropriate donor-recipient matching, and long-term monitoring are ensured. Domino liver transplantation not only optimizes the utility of available organs but also embodies ethical complexity, requiring informed consent and ongoing surveillance to balance the benefits of life-saving transplantation against the potential late-onset effects of inherited metabolic diseases.