Given the aging population and despite advances in heart failure therapies, the number of patients with advanced heart failure in need of heart transplantation continues to increase, and the longstanding mismatch between organ demand and organ supply persists. In an effort to address this mismatch and expand the donor pool, a number of strategies are being pursued. This article reviews several of those strategies, including transplantation from hepatitis C virus-infected donors, transplantation from donors after circulatory death, the role of organ preservation technologies in facilitating transplantation of hearts that might otherwise be discarded, and the impact of public education and national donation policies.