Since its inception in the 1960s liver transplantation has seen such improvements in patient selection, surgical technique, perioperative care, and immunosuppression that it is now the treatment of choice for patients with liver failure. Indeed, like most other solid organ transplants, liver transplantation has become a victim of its own success with more patients now on the waiting list as the number of organ donors declines. Among the various approaches to increasing the number of donors, one of the most promising is the use of non-heart beating donors.

In general, liver donation rates are poor in the UK (13 per million population compared with 33 per million in Spain, the best in Europe; www.uktransplant.org). To use this scarce resource most effectively clinicians are restricting access to transplantation to patients with a 50% chance of survival at five years. This restrictive listing excludes many patients, particularly those with hepatocellular cancer and older recipients. Even so the supply is not able to meet demand. In the UK about 60 people die on the waiting list …