*Purpose: End stage liver disease is becoming more prevalent in the United States with approximately 4.9 million adults carrying the diagnosis. It is estimated that 40,000 deaths will occur each year due to liver disease. Liver transplantation offers the only solution for this illness, and the mortality rate on the liver transplant waiting list is approximately 5-10%. With a growing demand for liver transplantation, expanded criteria donors are increasingly utilized. Although it varies by center, expanded criteria donors typically include donation after circulatory death and those over the age of 50-60 years. These donors represent an under-utilized resource in liver transplantation. Our center reviewed 10 patients who received livers from expanded criteria donors, specifically DCD (donor after cardiac death) donors over the age of 50 years. The mortality rate was zero at 1 year post transplant. These donors are an important resource for patients on the waiting list, who may otherwise expire waiting for a liver, and we will show there use can be equally as successful as standard criteria donors.

*Methods: We analyzed the last 10 recipients of DCD livers over the age of 50. All donors received HTK as the flush solution, and the WIT (warm ischemia time) on average was below 30 minutes. We did not maintain a hard 30 minute cutoff in WIT, instead choosing to start the clock when the systolic blood pressure dropped below 60mmHg and/or SpO2 decreased below 80%. Keeping with those parameters, all donor livers had a WIT below 30minutes. In addition, we recently began using N-acetylcystine when the recipient was an-hepatic, in an attempt to reduce reperfusion injury.

*Results: The results of the last 10 recipients receiving a DCD donor over the age of 50 show 100% patient and graft survival at 1 year, and excellent graft function at discharge. The average length of stay was 12.9 days with the majority of the patients leaving the hospital in less than 7 days. In addition, there were no livers with primary non-function or with ischemic cholangiopathy.

*Conclusions: We believe that DCD donors over the age of 50 are a severely underutilized resource for liver transplant recipients. Certain factors may be considered for our success with these donors. Using HTK to flush the donor organs provides rapid cooling of the liver which would take considerably longer with Wisconsin solution. In addition, the rapidity with which the donor liver is excised and the portal vein is flushed and the liver further cooled contributes to the excellent graft function.

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