Heart transplantation (HT) remains the gold standard surgical treatment modality for patients suffering from advanced heart failure. As we embark on a new decade, new challenges to HT emerge, while many historical barriers persist. The new HT listing criteria are significantly more nuanced, and skillful maneuvering of patients though this new schema is essential for a prompt successful transplantation. A significant number of candidates have advanced renal disease or pulmonary hypertension, which may require dual-organ listing or use of MCS pre-transplant to ensure successful transplant. Finally, sensitization against HLA has long been a barrier to transplant; however, modern assays and novel drug therapies can provide solutions to these complicated cases. This session will focus strategies for optimizing patients prior to transplant and provide solutions for managing the most challenging clinical scenarios encountered in the year 2020.

• Describe the key points of the new heart allocation system, and apply these principles to patient cases to minimize waitlist time and optimize post-transplant options.
• Determine which patients with pre-existing renal disease will benefit from combined heart-kidney transplant.
• Effectively determine which heart transplant candidates with pulmonary hypertension can be managed with pharmacotherapy versus mechanical circulatory support modalities to facilitate a safe transplant.
• Construct strategies for identifying candidates for desensitization and design regimens utilizing novel agents to facilitate heart transplant in these patients.