Even if an impressive number of 6.337 organs from 1837 donors were transplanted in the Eurotransplant region in 2020 (a reduction of 667 donors compared to 2019), at the end of the year, the active waiting list remains high, with 14,020 patients (of whom 3502 on the waiting list for heart, lung, or liver transplantation) still in need of an organ upon which their lives depend [1]. Historically, organ donation from deceased donors was possible when they had explicitly expressed the will to donate and were determined to be brain dead, defined as the complete and irreversible loss of all brain functions, but this concept may reveal structural deficiency (recognition and reporting of potential donors, realization of donations) [2]. Ethical evolutions and new scientific insights have changed policies since these early years of cadaver organ donations. First, some countries, such as Austria, Belgium, the Netherlands, and Spain, now have presumed consent or opt-out (instead of opt-in) donor legislations, and Ireland is expected to implement such a legislation soon. These countries typically have high donor rates. In ethical considerations of opt-in or opt-out regulations, important reflections on the weighting of the principles of autonomy, benevolence, solidarity and liberty of the individual are inherent. But whatever the system chosen, trust must be generated by adequate and fair communication [3]. Second, in patients who do not meet formal brain death criteria, donation after cardiac or cardiocirculatory death (DCCD), previously known as ‘non-heart-beating’ donation, is an alternative option. This can be performed following unsuccessful resuscitation in an uncontrolled DCCD protocol but is more frequently done in the context of controlled DCCD (cDCCD) following withdrawal of life-sustaining therapies (WLST) [4].