Introduction: Existing donor and composite liver transplant scores quantify perioperative risk but largely omit body composition and metabolic mismatch between donor and recipient. A novel VAT-focused donor–recipient scoring system (V-FIT: Visceral Fat and Frailty Index Threshold Score) has been developed to integrate key donor and recipient characteristics, as well as the donation pathway, with the aim of refining the prediction of graft outcomes, particularly early allograft dysfunction (EAD), biliary complications, and long-term survival. The proposed scoring system includes inputs such as donor VAT (high/low), age, steatosis (≥30%/<30%), and DCD/DBD pathway, in addition to recipient VAT, MELD (>20/≤20), age, and steatotic liver disease. Each variable is weighted (DCD = 2, steatosis ≥30% = 2; other adverse factors = 1), resulting in a 0–9 score stratified as low (0–3), medium (4–6), and high risk (7–9), with corresponding recommendations ranging from standard implantation to machine perfusion or graft avoidance. Unlike currently utilized scores, V-FIT is the first to prioritize imaging-defined VAT in both donor and recipient, directly addressing mechanisms such as ischaemia-reperfusion injury, biliary complications, and early allograft dysfunction that are biologically linked to metabolic phenotype rather than BMI alone. Results: The V-FIT Score is expected to show superior discrimination for graft loss and EAD, particularly in obese donors and DCD grafts, by capturing metabolic mismatch. High-risk combinations (for example, high donor and recipient VAT with DCD) are anticipated to be identified, which are associated with increased biliary and ischaemia-reperfusion injury risks, where standard scores may underestimate the danger. Conclusion: Current liver transplant scores quantify surgical and logistic risk but neglect donor–recipient metabolic mismatch. A VAT-based, bidirectional donor–recipient score delivers a novel, mechanistically grounded framework.