Advances in surgical techniques, postoperative care, and immunosuppression have led to greatly improved survival following cardiac transplantation in the past two decades. Patients expiring from overwhelming infection have traditionally been excluded from donor evaluation due to potential transmission of pathogens. Studies of donor-related tumor transmission to transplant recipients usually distinguish between central nervous system (CNS) and non-CNS donor malignancies. Case reports have described the transplantation of hearts from donors poisoned with tricyclic antidepressants with satisfactory graft function. Recent case series report a 15-30 percentage prevalence of left ventricular hypertrophy (LVH) in donor hearts accepted for transplantation. LV dysfunction is the most frequently cited reason for non-utilization of potential cardiac allografts. Due to the severe donor organ shortage, with long recipient waiting times, non-standard or marginal donor hearts are increasingly being used for higher risk recipients and critically ill patients, leading to an expansion of both the donor and recipient pools.