**6.6 Donation after circulatory death (DCD)**

Donation after brain death (DBD) has been the primary method of heart procurement. This procedure allows the surgeons to assess visual cardiac function and anatomy and minimizes ischemic injury by controlled cardioplegic arrest. The ISHLT registry data shows that the heart recipient and donor age and comorbidities have been increasing [1]. As demand for heart donors continues to increase, DCD heart donors have become an important alternative in the expansion of the heart donor pool. However, a period of warm ischemic injury occurs during the procurement process when life support is withdrawn to allow electromechanical arrest. DCD procurement techniques and organ preservation methods have been developed to minimize ischemic times [20].

DCD donor categories were classified by the modified Maastricht criteria (**Table 1**) in 1995 [45]. At the present time, DCD donors are classified as controlled DCD or Masstricht category III: Irreversible neurological injury but not meeting the brain death criteria [8, 45–47].
