Like in most aspects of life , doing more makes one better at doing it – Practice makes perfect. This truth is no different in Liver Transplant services . The more procedures done in an institution , the outcomes tend to be better as experiential learning and honing of skills is achieved along with the ability to “salvage” more in difficult and complex situations . However , in the real world , all Liver transplants just cannot be concentrated in high volume centres due to various reasons . In a small South east Asian country like Singapore with a population of 5.7 million , there is no option but to offer such a complex service locally to benefit the large number of patients with liver disease but still cannot aspire to become a high volume centre . This situation is not uncommon in many parts of the world due to disparity in access to care , geographical distances for travel , health care structure and policies and financial situation . This results in many low and mid – volume liver transplant centres existing and developing in many parts of the world . Small volume of liver transplants performed poses many disadvantages and challenges – some of them resulting in lower accessibility to organs for transplant , lack of protection should a transplanted organ not function fully , or indeed an inferior overall outcome compared with “gold standard” outcomes achieved at high volume centres . To circumvent these disadvantages and deliver the highest standard of care to their patients the leadership in these low and medium volume centres need to strategise and implement policies which should also include constant bench marking with published results from International literature that will mainly be from high volume centres . I will be sharing our results in liver transplantation from our centre in Singapore ( NUCOT) that will be designated as a medium volume centre by many accepted criteria in the literature . The results when benchmarked against available larger cohorts in the literature from high volume centres will demonstrate results at par with these high volume centres . Finally some of the strategies deployed over the years which might have contributed to this success will be discussed . Some of these strategies may help other low to medium volume centres or indeed help aspirational centres embarking on starting a Liver transplant programme .