Key Points

• Donor selection and management techniques are rapidly evolving.
• Optimal recipients are paired with optimal donors via a multidisciplinary and thorough evaluation that may vary by center.
• Age, blood type, BMI, and sex are among the most important factors when considering donor and recipient characteristics. Donor age less than 60 years, BMI within 30% of the recipient’s, and sex matching offer the best outcomes.
• Organ protection and transportation strategies are continually improving. While cold ischemic times of less than 6 hours are preferable, novel techniques utilizing ex-vivo autoperfusion may allow for acceptable outcomes with longer transport times.
• The donor pool is expanding through the use of marginal / high-risk donors, ex-vivo perfusion strategies, and donation after cardio-circulatory death (DCD). The number of hearts transplanted using these criteria is increasing year after year.