The unique syndrome of brain death is associated with cardiac dysfunction; however, if such a heart is removed from this environment and transplanted, the cardiac dysfunction often resolves. This scenario offers insight into the mechanisms of reversible forms of cardiac injury and suggests that treatment of the extra-cardiac milieu by removing the initiating insult can often result in recovery. The mechanisms leading to reversible cardiac dysfunction are discussed in this review, with concentration on the implications of such injury in determining outcomes following transplantation.