Heart transplantation (HT) is markedly constrained due to a critical shortage of suitable organs from donors in brain death (DBD). Transplantation of hearts donated after circulatory death (DCD) has emerged as a potentially valuable strategy used to address the critical shortage of suitable organs. Although excellent clinical results have been published for DCD heart procurement from controlled DCD donors (1), data from heart donation following euthanasia are scarce (2). The practice of euthanasia is legal in a limited number of countries (3). Organ donation after euthanasia raises several legal and ethical controversies and currently this practice is only performed in Belgium, the Netherlands, Spain and Canada in very restricted conditions. Indeed, euthanasia for adults was legalized in Belgium in 2002, within the legal and ethical framework defined in the Belgian Act on Euthanasia. The patient must find him or herself in a medically futile situation, of constant and unbearable physical or mental suffering without any prospect of recovery, resulting from a serious and incurable disorder caused by illness.

Donation after euthanasia could potentially help ease the shortage of organs for transplantation, and reduce the transplant waiting list. In fact, it is estimated that 10% of all patients undergoing euthanasia in Belgium could potentially donate at least one organ (4). In organ donation after euthanasia, the procurement procedure is performed after the declaration of circulatory death. Compared with DBD, grafts recovered as DCD undergo an additional warm ischemic insult due to progressive hypoxia and the circulatory arrest occurring between the lethal injection and the declaration of death. However, recent studies have concluded that organs such as kidneys, livers and lungs transplanted following euthanasia yield similar, and sometimes even superior, outcomes compared to other controlled DCD (5–7). To our knowledge, there has been only one report on human HT following donation after euthanasia (2). An experimental paper evaluating the function of human hearts donated after euthanasia described the procurement of two hearts donated after euthanasia for research purposes, using the direct procurement and machine perfusion technique