Advances in immunosuppressive therapies and surgical and organ preservation techniques have significantly improved transplant patient outcomes. Inevitably, multiorgan transplants involving heart transplantation (HTx) have steadily increased in the United States. Given the scarcity of organ donors, appropriate allocation of these resources is essential. The approach to HTx candidates with concomitant organ dysfunction necessitates multidisciplinary collaboration between subspecialties and transplantation surgeons. This chapter will cover the clinical aspects, indications, donor-recipient considerations, and management of combined HTx organ transplants.