In 1935, Carrel and Lindbergh first described the preservation of the cat thyroid by extra-corporeal perfusion for up to 18 days. Since then, there has been a myriad of work done in the field particularly in its applicability to organ transplantation. The last decade has seen a number of devices and technologies gain clinical approval for application in organ preservation prior to deceased donor transplantation. These technologies are broadly divided into regional and machine perfusion and further subdivided on preservation temperatures (normothermic, subnormothermic and hypothermic). For the first time in the history of transplantation, these technologies have allowed clinicians and scientists to test viability, resuscitate and, in some instances, treat liver grafts prior to organ transplantation. The rapid expansion in the field has meant that clinical applicability is approaching precision decision making in optimizing grafts in the context of fibrosis, steatosis and donation after cardiac death for example. Furthermore, these technologies have allowed for safe acceptance of extended criteria donor grafts and thereby increasing the donor pool. However, the application and adoption of these technologies have implications on workflows and cost to the running of a transplant programme. In this talk, the clinical and basic science developments in the field will be discussed along with its potential role in revolutionizing deceased donor liver transplantation.