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A critical, worldwide shortage of thoracic organs exists. The donor management program at Papworth Hospital, National Health Service Trust, Cambridge, United Kingdom, allows satisfactory transplantation of thoracic organs that initially appear unsuitable. The perioperative organ retrieval team members assess the cardiovascular status of all potential donors and manage suboptimal hemodynamics with hormonal replacement therapy consisting of triiodathyronine, antidiuretic hormone, epinephrine, and insulin. These donors' cardiovascular and pulmonary functions must be within acceptable limbs at the time of organ excision. Our standardized approach facilitates objective decision making regarding the appropriate use of donor organs and has increased the number of available donor organs at Papworth Hospital by 30%. Morbidity and mortality rates in thoracic organ recipients have not increased since the authors developed the standardized approach, and more patients have benefited from thoracic organ transplantation. AORN J 63 (Feb 1996) 416-426., The demand for thoracic organs for transplantation significantly outweighs the supply of available organs. There are more than 50,000 US patients awaiting cardiac transplantation, but hearts are procured from only [...]