Infection remains a major source of morbidity and mortality in patients with MCS despite significant progress in the development of more durable VADs and advances in surgical techniques over the last decade [25, 176]. The most recent INTERMACS report showed that infection was still the fourth most common cause of death within 1 year after implant [25]. The International Society of Heart and Lung Transplantation recognized the importance of clearly defining infection in this unique population and commissioned an international working group of experts to develop definitions of infection in patients with MCS that were published in 2011 [363]. Hence, these international definitions are recommended for defining infection in Europe and are part of this European consensus document.