The current crisis in organ availability will only be solved by aggressive and innovative solutions. One approach, outlined here, is to more carefully assess current donors and determine how to safely "push the limits" of acceptable cadaveric liver donors. Our experience, as well as that of others, indicates that donors with these higher risk factors may be used in certain carefully defined situations. The key elements to an appropriate use of these donors are careful donor and recipient assessment, and avoiding the presence of multiple risk-factors. These guidelines form a foundation for continuing assessment of methods to increase, in an incremental fashion, the number of cadaver livers successfully transplanted.