Purpose: Hypothermic Oxygenated Perfusion (HOPE) has been in use within the Australia-New Zealand (ANZ) region since March 2021. This technology has drastically changed the approach to donor heart preservation for prolonged periods in a geographically disperse region. Traditionally, prolonged ischaemic time (particularly more than 4 hours) has been a key limitation in heart transplantation, resulting in increased primary graft failure and post-operative mechanical circulatory support use. This study is a collaborative multi-centre review of outcomes utilising the HOPE technology across ANZ transplant centres. Methods: Data was obtained from the four adult cardiac transplant centres across ANZ utilising the XVIVO HOPE system (St Vincent’s Hospital Sydney, The Alfred Hospital, Auckland City Hospital, Fiona Stanley Hospital). The period of data collection covered March 2021 – July 2024. Results: 83 patients received a heart preserved by the XVIVO HOPE system. 63 patients were male (76%) and 20 patients were female (24%). Median recipient age was 53 years (IQR 44-61). Median heart preservation time was 354 minutes (IQR 299-417). Median XVIVO HOPE time was 254 minutes (IQR 194-326). 71 patients (86%) were successfully weaned from cardiopulmonary bypass, with 12 patients (14%) requiring temporary mechanical support. Median ICU length of stay was 6 days (IQR 14-51). Median post-operative length of stay was 23 days (IQR 14-51). 5 patients (6%) died within 30 days of their transplant. Conclusion: The early experience using HOPE technology has been encouraging in the ANZ region. Despite a median preservation time of almost 6 hours, 30-day mortality was only 6% and the need for post-operative temporary mechanical circulatory support was 14%. The ANZ regional experience will likely have practice changing implications for cardiac preservation, particularly in geographically vast regions and cases with unexpected prolongation of donor preservation time.