Abstract
One significant challenge in heart transplant (HT) is the shortage of grafts and underutilization of the donor pool. This study analyzes the unique characteristics of the HT program in the Canary Islands, established in 2019, which operates with a predominantly self-sustaining donor pool. A retrospective review of the Spanish HT Registry and National Transplant Organization reports between 2020 and 2024 revealed that 97% of transplanted hearts originated from local donors. The geographical constraints of the islands create an unresolved issue with ischemic time, prompting the Canary region to establish a new HT program based on donation after circulatory death and extended criteria donors. These 2 initiatives have increased the donor pool and transplantation rates, while maintaining ethical allocation and comparable survival rates. This model highlights how regional programs can improve the underutilized donor pool and transplantation opportunities, offering a framework for future initiatives to optimize donation.