For many individuals, religious beliefs and spirituality provide a core foundational element to their whole personhood. It is beneficial to include spiritual care in a holistic approach for optimal outcomes throughout a provider and patient relationship, particularly in conversation about end-of-life decision-making regarding left ventricular assist devices (LVADs) and total artificial hearts (TAHs). (Note: for the purpose of this chapter, these terms will be referred to as mechanical circulatory devices, MCDs.) The complex nature and length of the relationship between the patient and the provider for MCDs benefits from the application of a spiritual care assessment and understanding from the first meeting between provider and patient. Assessing the spiritual needs of patients can aid providers as they seek to treat the whole person and encourage autonomy in decision-making. Though religious and spiritual beliefs are diverse and broad, we intend to provide a foundational understanding of six of the world religions practiced in the United States, and introduction to the HOPE assessment tool will begin to support providers in meeting the religious, spiritual, and emotional needs of patients with or receiving MCDs. Starting the relationship with a well-structured conversation between the provider, the patient, and their family can minimize misunderstandings along with potential suffering that such misconception brings throughout care, with special consideration for pediatric care.