Key Points

• Heart transplant remains an excellent replacement therapy for end stage heart failure
• There remains a shortage of donors for an increased demand
• To increase the donor supply, marginal donors, organ preservation systems and donation after cardiac death donors are being utilized.
• A shift in allocation system was initiated in 2019; it has favored sicker patients and has led to decreased utilization of left ventricular assist devices as a bridge to transplant
• Mortality following heart transplantation is usually secondary to primary graft failure in the first month, opportunistic infection in the first year, acute allograft rejection in the first three years and cardiac allograft vasculopathy or malignancy in the first ten years
• Advances in genetic engineering (transgenic pigs) have laid the foundation for forthcoming xenotransplantation trials.