Creating a more just system for and clarifying the risks of a patient’s prospects for success in heart allocation (with the lung-allocation score being a good example of a suitable system [56]) has long been discussed. Sufficient long-term experience with MCS is still lacking, and satisfactory data from databases are only just beginning to be available. There are no substantiated scoring systems available that are capable of estimating device-related complications. Because of this gap in knowledge, it is impossible to balance the risk-benefit ratio of patients with MCS awaiting a heart transplant against those without MCS. So, use of a VAD might currently be deemed to be responsible for a lower status on the waiting list and therefore worse organ allocation. These problems need to be solved by creating a suitable scoring system for the allocation of hearts.