Multiple approaches in recent years have been implemented to address the persistent shortage of heart donors, including a recent modification of UNOS heart allocation system, expanding donor acceptance criteria, and adoption of novel techniques to utilize hearts from donors with circulatory death. The opioid epidemic has resulted in an exponential increase in deaths in the United States in recent years, particularly affecting younger adults. A recent analysis of UNOS database by Jenser et al. reveals a relative underutilization of heart donors with cardiovascular mechanism of brain death which provide similar long-term survival as donors with other mechanisms of brain death, highlighting the potential role of these donors to provide life saving cardiac allografts and mitigate the persistent shortage of hearts for transplantation.