Heart allotransplantation has become one of the methods of choice in the
treatment of severe heart failure. In the face of its difficulties, such
as the unmet balance between organ supply and demand, the use of
xenotransplantation might be an attractive option in the near future,
even more with the ongoing progress achieved regarding the avoidance of
hyperacute rejection and primary organ disfunction, maintenance of
xenograft function and control of xenograft growth. To make possible
this translational challenge, some points must be taken into account
indeed, and they are the equipoise of human benefit and animal
suffering, the risk of unknown infections, a well prepared informed
consent, ethical and religious beliefs, and the role of cardiac
xenotransplantation in a ventricular assistance device era.