Death has a single definition in medical terms: the irreversible cessation of brain functions. This condition can be determined in two different ways:

1. Neurological determination, in which the donor is brain-dead but the heart continues to beat.
2. Cardiological determination, based on the recording of a flat electrocardiogram (ECG). The time required for a flat ECG to certify death varies according to national regulations: in Italy it is 20 minutes, while in Anglo-Saxon countries it ranges from 2 to 5 minutes (Australia), and 5 minutes (United States and United Kingdom).

In May 2023, in Padua, Professor Gerosa and his team performed the first heart transplant in Italy from a donor after circulatory death, and the first in the world carried out after a period of warm functional ischemia exceeding 45 minutes (that is, the time interval from when the heart begins to suffer until cardiac arrest), followed by the 20 minutes required to certify death through a flat ECG.

Since then, more than 90 transplants have been performed in Italy using this method, with consistently effective recovery of heart function. The introduction of this procedure has increased the number of hearts available in Italy by approximately 10%, providing a concrete therapeutic option for a greater number of patients awaiting transplantation.