The gold standard and sole curative therapy for advanced stage heart failure is 
cardiac transplantation. As the population ages, the number of patients 
diagnosed with advanced heart failure and listed for transplant steadily 
increases annually. However, there remains a paucity of eligible donation after 
brain death (DBD) donor hearts which severely limits access to cardiac 
transplantation and leads to increasing wait-list times and avoidable patient 
mortalities. Though the first human heart transplant in 1967 was performed using 
a deceased donor heart, the advent of brain death criteria and the ability to 
avoid long warm ischemic times led donation after cardiac death (DCD) 
transplantation to fall out of favor. Due the current state of cardiac 
transplantation, there has been a resurgence in interest in DCD heart 
transplantation leading to the development of DCD heart transplantation programs 
in the UK and Australia after positive reports of successful DCD cardiac 
transplantation in the pediatric literature. These programs have demonstrated 
favorable post-transplantation outcomes equivalent to matched traditional DBD 
transplants with current techniques and strict donor criteria. This technique 
has been proven safe with favorable outcomes and has been demonstrated to 
significantly increase transplant volumes and decrease patient mortality. Given 
these outcomes and the high patient benefit to risk ratio, DCD donor heart 
transplantation is necessary to expand the donor pool and decrease patient 
mortality and should be developed in high volume experienced cardiac transplant 
centers.