© 2013 Springer Science+Business Media New York. All rights reserved. Myocardial insult or injury in the brain-dead organ donor stems from many factors, which are initiated and magnified by brain death, and modified beneficially or adversely by such factors as donor management and warm and cold ischemic times. Studies suggest that a prolonged period of ex vivo hypothermic storage of the heart further depletes myocardial energy stores and increases the impairment of cardiac function seen after brain death. However, storage is minimally detrimental if the potential organ donor has received hormonal therapy in the form of thyroid hormone replacement.