Thoracic organ procurement is a complex, multidisciplinary process that requires seamless coordination among anesthesiologists, transplant surgeons, organ procurement organizations (OPOs), and critical care teams to optimize donor management and facilitate successful heart and lung transplantation. In the United States, this process operates within a clearly defined legal and ethical framework overseen by the Organ Procurement and Transplantation Network, the United Network for Organ Sharing, and regional OPOs. Donation after brain death remains the predominant pathway for thoracic organ recovery, but donation after circulatory death (DCD) has steadily increased, now accounting for a growing proportion of donor cases. The rise in DCD introduces unique clinical, ethical, and logistical challenges, particularly in coordinating intraoperative care and adhering to institutional protocols. Advances in organ preservation, such as normothermic regional perfusion, ex vivo machine perfusion, and portable organ care systems, are increasingly utilized to extend preservation times and improve graft viability for heart and lung transplantation. Anesthesiologists play a central role throughout the procurement process, supporting hemodynamic stability, facilitating intraoperative workflow, and contributing to multidisciplinary decision-making. This chapter offers a practical, anesthesia-focused guide to thoracic organ procurement, highlighting current trends, emerging technologies, and key considerations in donor management.