*Purpose: Only 7% of livers transplanted in 2018 were from deceased from cardiac death (DCD) donors and only a minority of transplant centers aggressively utilize DCD donors. Not every attempted DCD procurement results in a transplant and costs associated with nonproductive DCD procurements are often viewed as a disincentive to aggressive DCD utilization. We examine productive DCD procurement rate from a purely financial perspective.

*Methods: We reviewed all DCD liver offers received in one year at The Ohio State University Wexner Medical Center beginning February 2019. We analyzed offer characteristics and collected cost and reimbursement data associated with procurement attempts and completed transplants. We then modelled the rate of productive DCD procurements required to maintain net financial neutrality.

*Results: 431 DCD liver offers were received. 57 offers (13.2%) were pursued and 36 successful transplants were performed (63% of total pursued). Pursued donors were located an average of 86 miles from our center (min 8, max 417). 47 organs were pursued using ground transportation and 10 utilizing air travel. For livers transplanted the average donor age was 36 and average BMI was 28. 48% of utilized donors were PHS increased risk and 14% were HepC NAT (+). Transplant recipients had a median MELD of 27 and 16% had HCC. Total reimbursements covered total procurement costs and with our 63% conversion rate a net positive margin was maintained.

*Conclusions: Aggressive pursuit of livers from DCD donors allowed for a 35% expansion of our transplant volume. Our productive DCD conversion rate was 63%. 36 additional lives were saved using DCD livers without adverse financial impact on our transplant center.

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