In the current era the majority of programs in the United States use a bicaval-left atrial cuff technique for pediatric heart transplantation. This chapter will review the basic steps of donor cardiectomy and discuss complications related to: (1) implantation, (2) left superior vena cava, (3) bilateral bidirectional Glenn shunts, (4) prior transposition of the great arteries, (5) hybrid interventions, and (6) situs inversus.