Heart transplantation is without doubt a very effective treatment for patients’ whose lives and well-being are threatened by their failing heart. We previously categorized our concerns into four areas or Ds: Donor availability, Disorganization, Disillusionment (of clinicians) and Disaffection (of tomorrow’s clinicians). After a decade, this is a timely reflection on this crisis of cardiac transplantation. It is also appropriate to set this in the context of a fifth D, the Demand for heart transplantation. In this reflective analysis, we use the 5 Ds to explore the current climate in heart transplantation, with particular reference to the situation in the UK.
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