Organic valve disease has been considered an absolute contraindication for acceptance as a donor heart. However, the severe shortage of donor hearts has prompted the use of marginally acceptable hearts to maximize the use of donor hearts. This report concerns a patient with repeated left ventricular assist system complications who underwent successful heart transplantation with a marginal donor heart requiring concomitant aortic valve replacement for mild aortic stenosis due to a calcified congenitally bicuspid valve.