High-risk donors: extending our criteria in times of organ shortageBernhardt, Alexander M.; Reichenspurner, HermannCurrent Opinion in Organ Transplantation: October 2014 - Volume 19 - Issue 5 - p 494–499 doi: 10.1097/MOT.0000000000000118 CARDIAC TRANSPLANTATION: Edited by Lars Gullestad Buy Abstract Author InformationAuthors Article MetricsMetrics 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. Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany Correspondence to Alexander M. Bernhardt, MD, Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany. Tel: +49 40 74105 2440; fax: +49 40 74105 4931; e-mail: Al.Bernhardt@uke.de, www.uhz.de Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.