In patients with advanced heart failure (AHF), guideline-directed medical therapies may not be sufficient for all patients, and advanced treat­ments may be required [1]. Heart transplant (HTx) evaluation is frequently requested in patients with AHF. The patient selection com­mittee of the transplant center determines the suitability of candidates for transplantation. Decisions of the committee are made by con­sensus. Committees should be open and include members from multiple disciplines. Often led by AHF and transplant cardiologists, and cardio­thoracic surgeons, the team reviews the clinical and psychosocial findings from the evaluation to determine whether the patient meets the criteria for HTx. They determine if the patient will rea­sonably expect to receive a substantial improve­ment in quantity and quality of life after an HTx and can be expected to adhere to a long-term disciplined medical regimen following trans­plantation. If there is no contraindication to HTx, the patient will be accepted by the com­mittee for listing for transplant. Complete details of the medical considerations behind transplan­tation listing are found in Chaps. 3 and 4.

Currently, in 2024, there are approximately 3400 patients waiting for a HTx in the United States, according to data from the Organ Procurement and Transplantation Network (OPTN). According to the Eurotransplant annual report, more than 1000 patients were active on the HTx waiting list. By the end of 2023 [2]. In countries across Asia, including India and Japan, HTx waiting lists also comprise several thousand patients. In the rest of the world, like Latin America, Africa, and the Middle East, data availability varies significantly, but the number of patients is generally lower due to fewer trans­plant centers and less frequent organ donation [3–5]. Overall, the global number of patients waiting for an HTx is estimated to be in the range of 10,000–15,000. This figure is likely underestimated the true demand due to less developed healthcare systems in some regions. According to data from the Global Observatory

There is a significantly higher prevalence of heart failure (HF) among racial and ethnic minorities and those impacted negatively by the social determinants of health [1]. Black adults have a 20-fold higher incidence of HF before age 50 years, and they exhibit the high­est rates of HF hospitalizations, readmissions, and 5‐year mortality risk after incident HF diagnosis [1]. However, the statistics on the medical care available for and offered to such patients are sobering. Black and Hispanic adults less often receive needed care by a cardiolo­gist when admitted for HF and are less likely to be referred to HF specialists or considered for advanced HF therapies [2, 3]. Additionally, black patients with left ventricular assist devices (LVAD) awaiting heart transplant (HTx) are less likely to be transplanted and more likely to be delisted [4]. Similarly, there is a dispro­portionately lower five‐year post-HTx survival in Black recipients compared to other minor­ity groups [5]. These racial and ethnic dis­parities in HF and HTx-related mortality are non-homogenously present across the USA. A study using data from the United Network for Organ Sharing and Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiological Research (CDC Wonder) pro­vides a geographical map of such disparities in outcomes over the period 2016–2018 [6]. The primary outcome examined in the study was the HTx to HF mortality rate ratio. Ratios were calculated for each race/ethnicity in the United States and by state as the number of HTs per 100,000 population divided by the age-adjusted HF mortality rate per 100,000 population [6]. The authors regarded the HTx to HF mortality ratio for White patients as the expected ratio for the other racial groups. Compared with White patients, the HTx/HF mortality ratio was lower than expected at 0.67 for African American patients and as expected at 0.92 for Hispanic patients on a national level [6]. Among the 30