BACKGROUND Thoracic organ procurement procedures have been standardized for decades, and serious organ injury during procurement is considered rare. However, when injuries do occur, they may result in irreversible loss of transplantable organs. CASE SUMMARY We report a rare case of unintentional donor heart injury caused by transdiaphragmatic liver core needle biopsy using a Tru-Cut–type device during multi-organ procurement. Two puncture injuries were identified on the inferior wall of the hear