Heart transplantation: the increasing challenges of evidence-based decision-making.

he benefit of heart transplantation has never been tested in randomized clinical trial because heart transplantation has lways been considered a breakthrough therapy according to riteria of evidence-based medicine, namely following early linical results from Stanford University (1). Although heart ransplantation has become the accepted gold standard for he treatment of carefully selected patients (2) with stage D eart failure (3), patient selection criteria for and outcomes fter heart transplantation have to constantly be reevaluated n the context of contemporary organ-saving therapies for dvanced heart failure. The Comparative Outcomes & linical Profiles in Transplantation study in Germany uggested that those patients who, according to the use of a alidated heart failure survival score (HFSS), would have he highest risk of dying from their heart failure would