*Purpose: Donation after cardiac death (DCD) allografts might represent one of the largest untapped sources of liver allografts. Our aim was to identify independent donor and recipient risk factors that predict mortality in DCD allograft recipients to select optimal candidates for successful transplants.

*Methods: Using the Organ Procurement and Transplantation Network database, we performed a univariate and multivariate retrospective analysis on 4,228 DCD liver allograft recipients.

*Results: We identified 11 significant factors and incorporated them into the weighted recipient selector index (RSI) to successfully predict 3-month survival following DCD liver transplantation with a C-statistic of 0.7040. MELD score components were included as individual predictors; thus, the novel DCD RSI (DCD Recipient Selector Index) can predict survival independently of MELD. The most significant recipient risk factors were recipient serum sodium levels greater than 150 mEq/L at transplant, donor age of 60-70 years, recipient albumin less than 2.0 g/dL at transplant and recipient INR of 3-3.5 at transplant. Donor risk index was not found to be a significant predictor.

*Conclusions: The DCD RSI can help quantify survival benefit for recipients and increase utilization of DCD donor allografts by matching the allograft to the recipient with the highest chance of success.

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