Dear Editor, Despite rationing access to the liver transplantation waiting list, there is a significant disparity between the number of recipients requiring transplantation and the number of donor organs available. This leads to a significant waiting list mortality, which has driven increased utilisation of “high risk” (marginal) grafts. Here the increased risk to the recipient’s life by using a less optimal donor organ has to be weighed against the risk of death on the waiting list whilst waiting for a more “optimal" graft.