To combat the national shortage of donor organs and meet the needs of more than 60,000 patients awaiting transplant, many organ procurement organizations have reevaluated non-heart-beating organ donation (NHBD) as one solution. Non-heart-beating donation is the process by which organs are recovered from patients after the pronouncement of death by cardiopulmonary criteria. Recent media reports have misled health care providers to believe that this is a new donation procedure; however, NHBD provided the foundation for modern clinical transplantation. This article describes non-heart-beating donor evaluation criteria, the donation process, associated ethical considerations and the role of the advance practice nurse in assisting families with this end-of-life decision. A case study will be presented followed by a summary of transplant recipient patient and graft survival outcomes.