Machine perfusion (MP) has been poised to change the face of liver transplant since the first use of hypothermic MP in 2004.¹ Since then, innumerable animal models and ex vivo experiments as well as single/multicenter retrospective trials have been published supporting the benefits of MP in liver transplant. The recent multicenter randomized clinical trial (RCT) by Markmann et al² evaluated the clinical effect of a portable normothermic MP in 300 liver transplants and adds to the 2 other MP RCTs in the literature.^3,4 In their study, Markmann et al found that livers that underwent normothermic MP had reduced early allograft dysfunction, decreased histologic evidence of ischemia-reperfusion injury, and decreased ischemic biliary complications at 6 and 12 months relative to controls.² However, the liver transplant community is still in need of guidance in how to best use this technology.