Abdominal Regional Perfusion in Donation After Cardiac Death for Multi-Organ Transplantation

Recipient Criteria: Inclusion Criteria- Indications for Liver transplant include decompensated Cirrhosis of any etiology Model for End-Stage Liver Disease (MELD) score \> 15 with no contraindications to liver transplant as per conventional clinical practice. Acute or fulminant liver failure Advanced malignancy such as HCC, cholangiocarcinoma, neuroendocrine tumor, or other cancer meeting criteria for listing and exception points as per current clinical guidelines. Exclusion Criteria- * Inadequate social support for liver transplant * Non-compliance with alcohol or narcotic cessation * Evidence of uncontrolled infection * Other untreated malignancy aside from those listed above * Physiologic evidence of frailty based on timed up and go, grip strength, 6 minute walk test, and cognitive testing. Donor Criteria: DCD donors offered via TGLN will be considered for assessment via abdominal regional perfusion based on the following parameters. These are in keeping with current criteria for abdominal organ donors. * Age: Up to 70 years of age within the initial evaluation period, with plans to expand to 75 y/o if initial results are favourable. * BMI: Donor BMI must be less than 30 for consideration * DCD donation criteria: Conventional criteria for DCD donation must be met, including no expectation for viable recovery, without meeting criteria for brain death, and expressed desire by family for organ donation. * Comorbidity: In the opinion of the on-call transplant surgeon, th…