A significant number of patients with end-stage liver disease secondary to hepatitis C die of disease-related complications. Liver transplantation offers the only effective alternative. Unfortunately, organ demand exceeds supply. Consequently, some transplant centers have used hepatitis C virus–positive (HCV+) donor livers for HCV+ recipients. This study reviews the clinical outcome of a large series of HCV+ recipients of HCV+ liver allografts and compares their course with that of HCV+ recipients of HCV-negative (HCV) allografts. The United Network for Organ Sharing Scientific Registry was reviewed for the period from April 1, 1994, to June 30, 1997. All HCV+ transplant recipients were analyzed. Two groups were identified: a group of HCV+ recipients of HCV+ donor livers (n = 96), and a group of HCV+ recipients of HCV donor livers (n = 2,827). A multivariate logistic regression model was used to determine the odds of graft failure and patient mortality, and unadjusted graft and patient survival were determined using the Kaplan-Meier method. There were no differences in demographic criteria between the groups. A greater percentage of patients with hepatocellular carcinoma received an HCV+ allograft (8.3% v 3.1%; P = .01). Patient survival showed a significant difference for the HCV+ group compared with the HCV group (90% v 77%; P = .01). Blood type group A, group B, group O incompatibility was significant, with 4.2% incompatibility in the HCV+ group and only 1.3% in the HCV group (P = .04). Donor hepatitis C status does not impact on graft or patient survival after liver transplantation for HCV+ recipients. Their survival was equivalent, if not better, compared with the control group. Using HCV+ donor livers for transplantation in HCV+ recipients safely and effectively expands the organ donor pool.