Inclusion Criteria:  Any sex/gender, 18 years of age or older listed for primary heart transplant. Subjects must be willing and be capable of understanding the purpose and risks of the study and must sign a statement of informed consent OR consent of a legally authorized representative of a cognitively impaired individual will be obtained before the cognitively impaired individual may be included in research. Signed: 1) written informed consent document and 2) authorization to use and disclose protected health information Subjects must receive and accept a non-local donor offer (from Northern California, Arizona, Nevada or farther geographies)  Exclusion Criteria:  Re-do heart transplant Multi-organ transplant