Donation after circulatory death (DCD) has re-emerged as a means of expanding the donor heart pool. Current clinical practice relies mainly on direct procurement followed by normothermic machine perfusion or on thoraco-abdominal normothermic regional perfusion. This paper details the practical aspects with an alternative strategy: direct procurement followed by hypothermic oxygenated perfusion (HOPE).

Key technical considerations include prevention of bubble formation in albumin-containing solutions and early machine priming to avoid ischemic delays. The final acceptance of grafts is based on a functional warm ischemic time <30 min, satisfactory cardioplegic flush and anatomy, and stable, uneventful machine perfusion.

Though this approach does not permit functional assessment of the graft, early results suggest that when strict donor and procedural criteria are observed, outcomes are favorable. Direct procurement of the DCD heart with HOPE offers a simplified, logistically efficient preservation method that avoids donor blood recirculation. Further studies are warranted to refine candidate selection and assess long-term results.