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Abstract: Objective: Over the past years both donor and recipient profiles have changed in heart transplantation. Satisfactory clinical outcomes of marginal donors in candidates >60 years of age have led us to allocate suboptimal donors to younger recipients as well. Therefore, we retrospectively reviewed our experience. Methods: Among 199 patients undergoing heart transplantation from January 2000 to February 2010, there were 83 (41%) aged 61–72 years. The other 116 (59%) ranged in age between 18 and 60 years. According to their clinical conditions as heart transplantation candidates, They were classified into 4 groups: younger recipients (n = 116) of either optimal donors (n = 72; group 1 [G1]) or marginal donors (n = 44; group 2 [G2]) and older recipients (n = 83) of either marginal grafts (n = 70, group 3 [G3]) or optimal grafts (n = 13; group 4 [G4]). The gender distribution, cause of end-stage heart failure, preoperative pulmonary hypertension incidence, pretransplantation clinical status, and mean follow-up were not significantly different among the 4 groups. Results: Overall 30-day survival was 90 ± 1% and 10-year rate was 78 ± 9%. Among the groups, 30-day and 10-year actuarial survival rates were, respectively: 94 ± 4% and 87 ± 1% for G1; 86 ± 5% and 84 ± 7% for G2; 88 ± 4% and 71 ± 7% for G3 and were 100% and 82 ± 7% for G4 (P = .7). In comparison among the 4 groups, there was no significant difference regarding freedom from graft failure (P = .3), right ventricular failure (P = .3), acute rejection episodes (P = .2), chronic rejection (P = .2), neoplasia (P = .5), or chronic renal failure (P = .1). Older recipients of marginal donors [G3] had a 4% (n = 3) prevalence of permanent pacemaker implant, versus G2: 3% (n = 2) among (P = .1). Conclusion: Our results suggest that extended donor and recipient criteria do not compromise clinical outcomes after transplantation. [Copyright &y& Elsevier]