Thoracic organ donation after circulatory determination of death

•Thoracic transplantation is limited by availability of donor organs from brain dead donors (DBD). Donation after circulatory death (DCD) provides facilitates the wish of individuals to donate organs who do not fulfill DBD criteria, thereby improving organ shortage and reducing wait list time and mortality while facilitating donation.•DCD results in additional warm ischemic time of the donor organ that can affect functional quality after transplantation.•Modalities to mitigate ischemia-reperfusion injury and assess the organ viability in DCD include regional normothermic perfusion (within the donor body) and ex-situ perfusion using hypothermic or normothermic systems.•Ex-situ systems allow careful assessment and optimization of the donor organ. In lung transplant many organs primarily deemed unusable for transplantation can become suitable with excellent post-transplant outcomes. This approach has significantly increased frequency of lung transplant, and reduced wait list times and mortality in the recipients. Limited data in heart transplantation suggests similar benefits.•Optimization of DCD and ex-situ perfusion systems for application in pediatric patients is required.•At present no widely adapted uniform criteria for determination of circulatory death have been put into consensus. Ethical concerns remain to be addressed and discussed and brought societal consensus has to be sought.