This week we delve into the world of heart failure and transplantation when we review a recent PHTS study assessing the impact of ischemic time on outcomes of pediatric heart transplantation. What is considered to be a long ischemic time and what is the impact on outcomes in the pediatric patient undergoing transplant? Why does it appear as the impact of a longer ischemic time is less associated with graft failure in the present era in comparison to the past? What might be the impact of newer heart perfusion devices used to transport organs for transplant? These are amongst the questions reviewed with Professor of Pediatrics at U. Colorado, Dr. Scott R. Auerbach. DOI: 10.1016/j.healun.2024.03.002