Continuous research is urgently needed to further boost the heart transplant and strengthen its position in the treatment of advanced heart failure as long as there is no effective causal therapy. Central topics remain, namely: Increasing organ donations by improving the identification of local heart donors, optimizing the reimbursement for explanting hospitals and, finally, enhancing donor willingness.
Expanding the donor pool (establishing early donor management programmes; assessing marginal donors in ex vivo perfusion systems; DCD donations; consideration of ABO-incompatible transplants in exceptional cases).
Improving organ allocation by considering post-transplant prognosis and the judicious allocation of highly urgent patients in view of the growing numbers of patients with mechanical assistance on the waiting list.
Improving organ retrieval and preservation procedures to minimize ischaemic injury and post-transplant outcomes.
Optimizing future immunosuppression procedures to prevent rejection and adverse long-term outcomes (e.g. cardiac allograft vasculopathy, malignancies). Because cardiac allograft vasculopathy is the biggest problem in regard to long-term mortality, all strategies designed to modify the immunosuppression regimen with the therapeutic options need to focus on that. In addition, long-term morbidity with renal function impairment may be the second most important factor that needs to be improved.
Increasing research for causal healing of cardiomyopathy and total cardiac replacement (e.g. durable total artificial hearts, xenotransplants).