Heart transplantation in the new era of extended donor criteria

We carefully read the recent paper by Hess et al.1 on the use of extended criteria donors (ECDs) to increase the organ offers. Heart transplantation (HT) is undoubtedly the best treatment for end-stage heart failure patients.2 However, the organ shortage remains a major challenge in cardiac surgery. Facing this problem, the medical community starts to extend the donor criteria to select more suitable organs for HT. The use of ECDs is still controversial since it is associated with a high incidence of primary graft failure,3 and although it guarantees longer survival than without transplantation, there is still some hesitation in accepting this practice.