Purpose of review: Increasing waiting lists and declining transplant numbers due to organ shortage are a global problem that needs a multimodal approach to overcome this situation. Extending the criteria for transplantation may be one part of the solution.
Recent findings: There are political efforts to increase the donor rate and change the listing criteria and the allocation process. Recently, the cardiac allocation score was introduced enhancing the factor urgency to the allocation process. Marginal donor organs can be accepted using ex-vivo perfusion strategies. Experimental approaches, such as donation after circulatory death and xenotransplantation, need to be further developed to be applied to humans and increase the pool of available transplant organs.
Summary: Organ shortage needs new approaches to overcome the discrepancy between the number of patients on the wait list and performed heart transplantations, reduce wait list mortality and improve long-term outcomes after transplantation.