This chapter will summarize significant racial, ethnic, and gender disparities in heart failure and heart transplant care in the United States of America and further underline shortcomings in expanding access to heart transplantation, the impact of socioeconomic stressors on transplant-related outcomes, and the implications of the new allocation system for improving access to transplantation for racial minority communities. Additionally, the chapter will outline future directions aimed at addressing these persistent disparities in care.