Colorectal cancer (CRC) is a leading cause of cancer-related mortality worldwide.
      Approximately half of all patients develop metastases, often to the liver or lung. Surgical
      treatment of liver metastases (LM) is the only curative treatment option; however, it has
      been estimated that only 20-40% of patients are candidates for liver resection. Surgery
      offers a distinct survival advantage: the 5-year survival after liver resection for LM is
      around 40-50% in most studies versus 10-20% 5-year survival for chemotherapy alone.

      In cases where the colorectal metastases are isolated to the liver but "unresectable", the
      total hepatectomy resulting from liver transplantation would remove all evident disease. CRC
      LM are considered an absolute contraindication for liver transplantation (LT) at most centers
      but recent reports of LT for colorectal LM from a single center in Oslo, Norway demonstrated
      a 5-year survival of 56%. The Norway study was not stringent about inclusion criteria or
      pre-transplant chemotherapy, and transplanted patients whose tumors were actively growing. As
      a result many participants developed disease recurrence quite rapidly following transplant.
      The investigators hypothesize that tighter criteria would result in improved outcomes.

      Unfortunately, with a lack of deceased donor grafts for the investigators existing transplant
      patients, the investigators cannot utilize decease donor grafts for this study. Therefore the
      investigators will explore Living Donor Liver Transplantation (LDLT). Furthermore, LDLT is an
      elective surgery, allowing for more control over pre-transplant chemotherapy and tumor
      monitoring. This study will offer live donor liver transplantation (LDLT) to select patients
      with unresectable metastases that are 1) limited to the liver and 2) stable (non-progressing)
      on standard chemotherapy. Potential participants will be evaluated for liver transplant
      suitability and must also have a willing, healthy living donor come forward for evaluation.
      Those participants who undergo LDLT will be followed for survival, disease-free survival and
      quality of life for 5 years and compared to a "control group" of participants who drop out of
      study prior to transplantation due to reasons other than cancer progression.