In this issue, Burstein et al1 describe acceptance rates and outcomes of heart transplant (HT) from donors with Public Health Service (PHS) risk criteria for infection transmission and compare the adult and pediatric experiences. The authors report increasing prevalence of donors with PHS criteria over the study period (2010 to 2021), representing 8.3% of pediatric and 25.2% of adult HT. There was no excess risk of death for adults or children receiving a heart with vs without PHS risk criteria. The study also identified a subgroup of hearts with PHS risk criteria that were initially declined for pediatric patients but subsequently transplanted into adults, with good outcomes. These data highlight potential underutilization of high-quality donor hearts with PHS criteria, particularly within pediatric HT programs.