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The availability of oral direct‐acting antivirals has altered the hepatitis C virus (HCV) treatment paradigm for both pre–liver transplant (LT) and post‐LT patients. There is a perceived trade‐off between pre‐LT versus post‐LT treatment of HCV—treatment may improve liver function but potentially decrease the likelihood of a necessary LT. Our objective was to identify LT‐eligible patients with decompensated cirrhosis who would benefit (and not benefit) from pre‐LT treatment based on their Model for End‐Stage Liver Disease (MELD) scores. We simulated a virtual trial comparing long‐term outcomes of pre‐LT versus post‐LT HCV treatment with oral direct‐acting antivirals for patients with MELD scores between 10 and 40. We developed a Markov‐based microsimulation model, which simulated the life course of patients on the transplant waiting list and after LT. Simulation of LT integrated data from recent trials of oral …