Solid organ transplantation has been and likely always will be a scarce resource. In the absence of some technological breakthrough, the supply of organs will always be inadequate to meet the demand, particularly as the long-term survival associated with transplant continues to exceed most alternatives.1 For heart transplantation, we have many issues, not the least of which are the complexities of determining donor quality, the complex acquisition process, and the need for immediate excellent function of cardiac allografts. In addition to these fixed issues, we have intense regulatory oversight which is a constant concern for programs in the United States.
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