© 2016 Elsevier Inc. Background Primary graft dysfunction (PGD) is a frequent complication after cardiac transplantation and remains one of the leading causes of mortality in these patients. The objective of this case-control study is to identify donor and surgical procedure's factors associated with PGD, and further guide possible strategies to prevent PGD. Methods Retrospective analysis of the medical records of patients who underwent cardiac transplantation at Memorial Hermann Hospital at Texas Medical Center between October 2012 and February 2015. Results The study population included 99 patients, of which 18 developed PGD. Univariate analysis of donor characteristics revealed opioid use (P =.049) and death owing to anoxia (P =.021) were associated with PGD. The recipient/donor blood type match AB/A was significantly associated with PGD (P =.031). Time from brain death to aortic cross clamp (TBDACC) of ≥3 and ≥5 days were also found to be associated with PGD (P =.0011 and.0003, respectively). Multivariate analysis confirmed that patients with a time from brain death to aortic cross clamp ≥3 and ≥5 days had lesser odds of developing PGD (odds ratio, 0.098 [P =.0026] and OR, 0.092 [P =.0017], respectively]. Conclusions Our study showed that a longer time from brain death to aortic cross clamp was associated with lower odds of developing PGD. Therefore, postponing heart procurement for a few days after brain death seems to be beneficial in preventing PGD.