Please select the eligibility criteria that correspond to the clinical trial below.
Title: Hypothermic Machine Preservation of Extended Criteria Liver Allografts for Transplantation
Brief Summary: This is a study comparing a technique of continuous circulation to the liver as a means of preventing liver damage during transportation to the transplant hospital. This new technique of Machine Perfusion (MP) will be compared to the standard technique where the liver is maintained in a bag of solution on ice without circulation. The investigators will evaluate and compare the outcomes of the transplants with the new technique to the standard technique. There will be 24 MP patient's in the study. The investigators have previously used this technique with success in 20 human liver transplant patients. The investigators think there will be a benefit in terms of less damage to and better function of the donor liver which will result in faster recovery for the patients. This protective effect may allow us to successfully transplant more patients and prevent people from dying while waiting for a liver transplant.


Options:
A: Inclusion Criteria:

* Signed written informed IRB consent by patient or patient's legally appointed representative.
* Be at least 18 years of age; male or female.
* Listed with UNOS for liver transplantation.
* Organ declined by at least one transplant center
* Extended criteria donor as defined by:

  * Presence of hepatitis C antibody
  * Donation after Cardiac Death (DCD)
  * Severe Hypernatremia: donor serum sodium \>165 meq/L for at least 12 hours prior to procurement
  * Donor age ≥65 years
  * Presence of significant steatosis \>25% macrovesicular by biopsy
  * Evidence of significant donor ischemic injury
  * Current donor serum aspartate aminotransferase (AST) or alanine aminotransferase (ALT) \>1000 IU/L
  * Ischemic injury evidenced by prolonged hypotension, high pressor requirement and/or rising serum liver function tests or one test more than five times the upper limit of normal (AST, ALT, or Total Bilirubin)

Exclusion Criteria:

* Patients in whom the donor liver will be subjected to less than 4 hours of cold ischemia (surgeon desires immediate implantation)
* Patient hospitalized in intensive care unit (ICU) at time of transplantation and/or physiologic MELD score \>35
* Dual organ recipient
* ABO incompatibility
* Retransplantation
B: Inclusion Criteria:

-Patients with signed informed consent, suffering from end stage-liver disease and/or malignant liver tumors listed for liver transplantation and receiving ECD organs.

ECD Criteria are defined as:

* Donors 65 years of age and older
* Intensive therapy of the donor was required before donation for at least 7 days, --Obesity of the donor with a Body Mass Index \> 30
* Fatty liver (with histology) \> 40 %
* Serum-Sodium \> 165 mmol/l
* Serum AST or ALT \> 3 x normal, Serum-Bilirubin \> 2 mg/dl)

Exclusion Criteria:

* Recipients of split of living donor liver transplants
* Previous liver transplantation
* Combined transplantations (liver-kidney, liver-lung, etc.)
* Participation in other liver related trials
* The subject received an investigational drug within 30 days prior to inclusion
* The subject is unwilling or unable to follow the procedures outlined in the protocol
* The subject is mentally or legally incapacitated
* Patient is not able to understand the procedures due to language barriers
* Family members of the investigators or employees of the participating department
C: Inclusion Criteria:

* Adult patients (≥ 18 years old)
* Signed informed consent
* Willing and able to attend follow-up examinations
* Donor liver graft from a controlled donation after circulatory death (Maastricht category III)
* Donors with a body weight ≥40 kg

Exclusion Criteria:

* Simultaneous participation in another clinical trial that might possibly influence this trial
* Mental conditions rendering the subject incapable to understand the nature, scope and consequences of the trial
* Listed for liver transplantation due to fulminant liver failure or retransplantation because of primary non-function
* Recipient positive test for HIV
* Donor positive for HIV antigen, hepatitis B core antibody, hepatitis B surface antigen, or hepatitis C antibody
* Simultaneous transplantation of another organ
* Patients with contra-indications for MRCP (i.e. pacemaker)
D: Inclusion Criteria:

* Registered male or female primary Liver transplant candidate
* Age ≥18 years old
* Signed: 1) written informed consent document and 2) authorization to use and disclose protected health information

Exclusion Criteria:

* Acute, fulminant liver failure
* Prior solid organ or bone marrow transplant
* Chronic use of hemodialysis or diagnosis of chronic renal failure, defined as chronic serum creatinine of \>3 mg/dl for \>2 weeks and/or requiring hemodialysis
* Multi-organ transplant
* Ventilator dependent
* Dependent on \> 1 IV inotrope to maintain hemodynamics

Answer: A