Lack of donor organ availability is an increasing problem in heart transplantation. Methods to safely increase the donor pool are desperately needed. We report four cases of coronary artery bypass during orthotopic heart transplantation for donor hearts with normal ventricular function and subclinical coronary artery disease. An aggressive approach toward utilizing hearts from older donors with normal ventricular function may expand the donor pool and decrease the waiting period, with its attendant death, for patients awaiting heart transplantation.