Heart failure is a major public health burden with an estimated global prevalence of over 26 million, leading to major economic loss. Severe advanced heart failure is estimated to exist in 1–2 million people worldwide who in the absence of advanced therapies (ventricular assist device or cardiac transplantation) are at high risk of death (up to 75% in 1 year).1,2

Heart transplantation is currently the gold standard treatment for refractory heart failure. Despite various advances, the prognosis and quality of life of patients with advanced heart failure (HF) remains poor. A shortage of donors limits the number of heart transplants, leading in turn to increased use of mechanical circulatory support devices.

Currently in the UK, approximately 15% of heart donations are post-circulatory death (DCD), with the remainder from donation after brain death (DBD).3 Increased use of DCD donation is perhaps the most significant change in recent years. The outcomes from DCD donation are similar to those from DBD donation, but there is an increased requirement for postoperative mechanical circulatory support in DCD donation.4