LAUSR

I n 2016, 3,191 individuals in the United States were fortunate enough to receive a cardiac transplant (1). Although the number of patients who received transplants in 2016 was the highest in Organ Procurement and Transplantation Network (OPTN) history, heart failure (HF) practitioners and their patients are keenly aware of the ongoing marked imbalance between organ demand and supply—an imbalance that is growing because more patients are surviving stage D HF with the advancement of mechanical circulatory support (MCS). In 2005, there were 2,712 patients listed for transplantation, of whom 138 (5.1%) had MCS in place at the time of listing (2). In 2015, the number of candidates on the wait list rose to 3,791, and 31% were on MCS at listing (2). Simultaneously, the numbers of individuals delisted due to progressive illness are also increasing. In 2005, 3.3% of all delisted patients (n 1⁄4 3,018) were removed due to progressive sickness compared with 9.3% of delisted patients (n 1⁄4 4,099) in 2015 (1). Currently, modifications to the adult transplantation allocation system within the United States are underway as a means of improving organ allocation to the sickest of listed patients (3). However, such modifications do not necessarily address the accelerating demand for donor organs. To address the U.S. donor recipient imbalance, at least 1 of 3 interventions must take place: 1) the duration of survival on MCS technology must