Donors After Circulatory Death Heart Trial

Inclusion criteria

Donor Inclusion * Maastricht Category III DCD donor, defined as expected death after the withdrawal of life- supportive therapy (WLST) * Donor age 18-49 years old inclusive * Warm ischemic time (WIT) ≤ 30 mins, with warm ischemic time defined as: Time from when mean systolic blood pressure (SBP) is \< 50 mmHg or peripheral saturation \< 70% to aortic cross-clamp and administration of cold cardioplegia in the donor. Donor Exclusion * Previous cardiac surgery * Known coronary artery disease * Cardiogenic shock or myocardial infarction, or * Sustained terminal ejection fraction (EF) of ≤ 50%, or * Significant valve disease except for competent bicuspid aortic valve Recipient Inclusion * Primary heart transplant candidates * Age ≥ 18 years old * Signed: (1) written informed consent document; (2) authorization to use and disclose protected health information; and (3) consent to TransMedics' use of recipients' United Network for Organ Sharing (UNOS)/Organ Procurement and Transplantation Network (OPTN) data and recipients' Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) data. Recipient Exclusion * Prior solid organ or bone marrow transplant * Chronic use of hemodialysis or diagnosis of chronic renal insufficiency * Multi-organ transplant * Investigator unwilling to randomize to either arm.