*Purpose: Liver allografts from donation after circulatory death (DCD) donors remain underutilized in the U.S. Improved utilization requires expanded potential donor identification by organ procurement organizations (OPOs), as well as organ placement at transplant centers willing to utilize these allografts. The purpose of this analysis was to identify current DCD liver offering and acceptance practices in order to develop new strategies to increase DCD liver utilization.

*Methods: Transplant surgeon surveys were distributed electronically to ASTS members, and OPO surveys were distributed electronically by AOPO.

*Results: 188 transplant surgeons and 48 OPOs responded. 78.4% of OPOs offer DCD livers from donors age >50. Although the majority of surgeons use a donor age limit of 50 or lower, 41.46% of surgeons accept donors age >50, and 12.8% report no upper limit of donor age. 48.78% of surgeons accept DCD liver donors with body mass index > 35, and 90% of OPOs offer these donor livers. 91.7% of OPOs offer hepatitis C-positive DCD livers, and 66.87% of surgeons report considering these organs for transplantation. Although donor-death prediction tools are used by 65% of OPOs, only 36.42% of surgeons and 16.77% of OPOs use these tools to decide which DCD liver donors to pursue.

*Conclusions: A large minority of transplant surgeons are willing to utilize expanded DCD liver donors including older donors, obese donors, and hepatitis C-positive donors. The majority of OPOs pursue these types of DCD liver donors. Organ placement systems which link these expanded DCD donor livers with centers willing to utilize these organs represent an opportunity for expanded DCD liver utilization. Donor-death prediction tools, although widely reported, have minimal impact on decision making at the surgeon and OPO levels.

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