Abstract: In the background of a severe shortage of donor livers, the use of extended criteria donor (ECD) liver has become an inevitable strategy in clinical practice. The authors summarize recent clinical advancements in the application of ECD in the fields of advanced donor age, hepatic steatosis, and virus‑positive donors, emphasize that the safety and efficacy of ECD utilization can be significantly improved through precise donor evaluation, optimal donor‑recipient matching, and the application of machine perfusion technologies. Additionally, the risks of post-transplant complications associated with ECD liver are examined, along with recent progress in organ preservation and maintenance techniques. Looking ahead to the future, it is necessary to establish a standardized assessment framework to further expand the donor liver pool and improve transplantation outcomes.