In a remarkable attempt, Sponga et al. successfully cleared the double hurdle of heart transplantation (HTx) in high-risk patients with grafts from marginal donors preserved with ex-vivo normothermic perfusion (EVP). Their results, obtained at University Hospital of Udine and Hannover Medical School, indicate effective reduction of graft ischemic time using EVP in this complex setting. Furthermore, their strategy allows continuous evaluation of graft function and viability during transportation. This could aid to extend the donor pool in complex settings with marginal donors and high-risk recipients. Thereby, patients who would otherwise be excluded from the possibility of HTx could receive adequate grafts.