Purpose of Review <p>This review summarizes current data with regards to patient selection for TIPS. Special consideration is given to optimal patient selection with the goal of reducing morbidity and mortality associated with the procedure.</p> Recent Findings <p>Prior studies have demonstrated a clear benefit of TIPS placement in patients with refractory ascites and recurrent variceal hemorrhage that have shaped current guidelines. Recent analyses challenge established patient selection models with a goal of better understanding how to optimize patient selection.</p> Summary <p>A comprehensive evaluation for consideration of TIPS placement should include an understanding of the indication, comprehensive echocardiography, and an individualized approach as well as be performed at a center with adequate procedural expertise. Clinical factors that should be considered include age of the patient, severity of liver disease, history of hepatic encephalopathy, frailty and sarcopenia, underlying cardiovascular and renal disease as well as social support.</p>