**7. Conclusions**

Heart transplantation remains the gold standard treatment for end-stage heart failure. Mechanical circulatory support with left ventricular assist devices (LVAD) can provide a bridge to transplantation but has not resulted in the best successful alternative treatment to heart transplantation but adding more risk and complexity during redo-surgery. The demand for heart donors continues to increase and extended criteria donors are being accepted more frequently. Continued research to develop new preservation techniques is crucial to the goals of increasing transport times and expanding the number of donors while preserving optimal allograft function.
