Who needs a heart transplant?The opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.

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Abstract
The aim of transplant assessment programmes is selecting a patient who will benefit from receiving a cardiac transplant. The recipient should be expected to live longer with a better quality of life when compared with continuing on medical (or other non-transplant) therapy. Until the mid-1990s, the management of heart failure comprised angiotensin-converting enzyme inhibitors (ACE), diuretics, and digoxin. With this limited armoury, there was consensus that many ambulant patients with NYHA classes III and IV chronic heart failure would benefit from heart transplantation. Since the late 1990s, there has been a dramatic change in the management of heart failure. Beta-adrenoreceptor, aldosterone and angiotensin receptor blockers, implantable cardioverter defibrillators, and cardiac resynchronization therapy have all become established therapies that reduce mortality rates.1–5 With this improvement in therapy for heart failure, we have to reassess who would benefit from heart transplantation.