Heart transplantation in Japan has been developed under severe donor shortage, and aggressive use of marginal donors (MD) seems inevitable. Major concern about the use of MD is the increased risk of primary graft failure (PGF). Therefore, it is crucial to conduct a risk analysis of transplant from marginal donors from the risk of PGF. Ninety-one cases of heart transplants performed at our institution were examined. Among the overall 10-year cumulative survival rate as 84%, the 10-year survival rate for the PGF(+) group (12 cases, 13%) was 50%, significantly worse than the 92% for the PGF(−) group. Multivariate analysis identified six risk factors for PGF: donor inotropic score, ischemic time, recipient Hb, cardiopulmonary arrest (CPA) time to harvest, donor cardiac function (EF), and donor age. The PGF risk score derived from these factors is 1.24 + 0.738 log (Donor inotropic score + 1) + 0.014 (Ischemic time) − 0.335 (Recipient Hb) − 0.086 (Time from CPA to Harvest) − 0.073 (Donor EF) + 0.027 (Donor Age), with a c-statistic of 0.785 obtained from the ROC curve.