Substantial evidence is underscoring the importance of a combined assessment of liver and kidney function in patients with refractory heart failure, to stratify early post- heart transplant risk: multi-organ dysfunction, while identifying sickest patients on the list is also associated with a high risk of post transplant complications. In this issue of the Journal, Dr. Lebray provides an analysis of combined kidney and liver function patients undergoing heart transplant, identifying potential boundaries for futility of transplantation, because of excessive post-operative risk. Further development of this concept may help to design prioritisation algorithms allocating the organ to HT candidates not only based on the risk of dying on the waiting list, but also on the chances to survive after transplant.