Candidate selection for heart transplantation in the 21st Century

Cardiac failure is an important problem in developed countries with impacts on patient prognosis, quality of life, and economic cost. Although heart transplantation is the only established therapy for advanced heart failure, it is limited by donor organ shortage. Medical therapy should be optimized before transplant assessment, and patients should be offered the option of alternative surgical therapy when possible. Appropriate candidate selection by precise risk stratification and exclusion of patients with unacceptable risk will ensure best utilization of a scarce resource to patients who will derive the most benefit.