Heart Transplantation (HTx) is considered the gold standard for the treatment of refractory end-stage heart failure. Due to the scarcity of available donor hearts, careful evaluation for HTx candidacy is warranted. Thus, the goal of a HTx evaluation is to determine if: the patient’s cardiac status is limited enough, on optimal medical therapy, to benefit from HTx; the patient does not have co-morbidities that would preclude HTx; and the patient demonstrates compliance and possesses adequate social support. Finding a balance between maximal individual survival benefit and maximal utility will always remain a complex issue requiring frequent reassessment. Ultimately, the decision to list a patient for transplantation is not based on any one test or factor but acknowledges multiple factors, including indicators for poor prognosis without transplant as well as potential contraindications that may cause suboptimal outcomes post-transplant. This chapter will summarize the contraindications to HTx as well as psychological and financial considerations.