Beating heart transplantation or ‘Heart in the box” is a new technology being perfected by UCLA (University of California, Los Angeles) Health System which keeps the donor heart beating in a near physiologic state during transportation till implantation in the recipient. This enables preservation of the donor heart and could potentially facilitate long distance transport to achieve better tissue matching to reduce the chance of graft rejection. Conventionally the donor hearts have been transported in ice boxes, which would limit the time for which they would remain viable, which is currently at a cut off of six hours. The new technology known as Organ Care System (OCS) has been developed by Transmedics, perfused the heart with oxygen and nutrient rich blood and is maintained at a controlled optimal temperature. Cardiac function during transport is monitored and displayed as well. A randomized controlled trial to enroll 128 patients is being planned by the UCLA team, in a multicentric phase 2 clinical study. This trial will compare the conventional ice box transfer with this new “Heart in the box” or beating heart transplantation technology with Organ Care System. The trial has been named “Prospective, Randomized, Multicenter Safety and Effectiveness Evaluation of the Organ Care System Device for Cardiac Use” (PROCEED II). (Information derived from the official UCLA Health web page: http://www.uclahealth.org/body.cfm?id=561&action=detail&ref=1560). We will have to await the final results of PROCEED II trial to know more about the success rates of the beating heart transplantation technology over and above the conventional ice box transfer technique of donor hearts for transplantation.