“…Percutaneous Mechanical Circulatory Support (MCS) devices have improved both preoperative optimization and postoperative recovery in patients with cardiogenic shock and primary graft failure 4,5 . A pig heart was recently transplanted into a human recipient 6 . But as the work of Siddiqi and colleagues suggests, perhaps the most significant disruptions to the management of advanced heart failure occurred with the United Network for Organ Sharing (UNOS) policy changes on October 18, 2018 7 …”