A Review of Risk Assessment in the Evolving Heart Transplant Landscape

Heart transplantation remains a vital therapy for patients with end-stage heart failure, yet organ scarcity and evolving allocation policies necessitate robust risk prediction models to optimize outcomes and equity. This narrative review explores the current landscape of risk assessment in heart transplantation, contextualized within the broader framework of solid organ allocation and the emerging continuous distribution (CD) model. While kidney, liver, and lung transplantation have integrated validated risk scores into allocation systems, heart transplantation continues to rely on therapy-based criteria without a unified, benefit-based approach. We examine existing pre- and post-transplant predictive models and highlight their strengths and limitations. Additionally, we discuss the multidimensional factors influencing transplant success, ranging from donor and recipient characteristics to psychosocial and system-level variables. As CD expands across organ types, the development and integration of validated heart-specific risk scores will be essential to ensure equitable and effective organ allocation.