Advanced recipient age represents a contraindication in numerous transplant centers worldwide. Due to mprovements in immunosuppression and therefore also of long-term results after heart transplantation, more and more older patients are being listed for transplantation. The present paper describes the literature regarding heart transplantation in advanced age. Nevertheless, because of new allocation strategies in times of persistent donor organ shortage, heart transplantation could be restricted to younger recipients in the near future. Therefore, in the second part of the present paper the so-called destination therapy as an alternative to heart transplantation is described. © 2013 Springer-Verlag Berlin Heidelberg.
