**2. Heart donation**

Heart transplantation was first performed by Christiaan Barnard in 1967 with a DCD approach. The recipient and donor were in adjacent operating rooms. Donor life support was discontinued, and death was pronounced after there was no electrical activity for 5 minutes. The chest was opened, cardiopulmonary bypass was initiated, cardiectomy was performed and the donor heart was perfused through the aortic root until the recipient was ready to implant. The transplant was successful, and the recipient was able to wean off from cardiopulmonary bypass. Unfortunately, the recipient passed away 18 days postoperatively due to pneumonia and acute rejection [6–8].

In 1968, the Harvard Ad Hoc committee included "irreversible coma" to be the criteria for death. Since then, DBD has become the majority method of heart retrieval with the benefit of controlled rapid diastolic cardiac arrest and shorter ischemic time [9]. In 1979, the Stanford team reported the experience of heart procurement at an outside hospital and found it to have equivalent outcomes compared to donor hearts procured in a hospital which led to nationwide organ sharing to increase the donor pool and subsequently decreased waitlist times [10]. The technique of heart preservation after initial cardioplegia infusion was cold storage with topical hypothermia. A Stanford experimental study demonstrated significant ultrastructural changes after 3–4 hours of ischemia which appeared reversible with satisfactory graft function [11].
