<p>Heart transplantation remains the gold standard for the treatment of advanced heart failure with reduced ejection fraction that is refractory to the best possible pharmacotherapeutic, interventional and surgical treatment. With modern treatment methods, more and more heart failure patients are experiencing an advanced stage of the disease, in which a&#xa0;corresponding comorbidity profile often makes candidate selection for heart transplantation more difficult. Close cooperation within the interdisciplinary heart transplantation team is mandatory to select an adequate treatment for each patient in the complex interaction between urgency and prospects of success. One of the current challenges is the continuing serious shortage of donor organs despite all efforts, which goes hand in hand with ongoing efforts to improve the current distribution system. Despite some progress, the option of xenotransplantation in the field of the heart is not yet within reach.</p>