Evolving role of cardiac transplantation for end-stage congestive heart failure

The dramatic efficacy of cardiac replacement therapy, an expanding population of potential recipients, and a shrinking donor supply have converged to create thorny medical and ethical issues for practitioners and patients. Based on scientific evaluation of current practice, new policies are being considered to optimize outcomes for end-stage heart failure patients in an equitable way. Meanwhile, improving efficacy of mechanical assist devices may soon justify transitioning from “bridge-to-transplant” to “destination therapy” as a standard approach for those who cannot safely await a transplant, further altering the landscape of surgical therapy for end stage heart failure. In this review, selected aspects of heart transplantation of interest to the broader transplant community are briefly reviewed, focusing on recipient and donor selection, surgical considerations, and subsequent management.