Álvero Pedraz Prieto, MD, a cardiothoracic surgeon at Gregorio Marañón Hospital in Madrid, discusses heart transplantation in Spain and bridging patients to transplantation with Impella® support. He explains that improvement in management of cardiogenic shock and a heart donor shortage in Spain have resulted in an increase in the number of patients requiring mechanical circulatory support (MCS) as a bridge to transplant. He presents 5 case studies of patients supported with Impella until heart transplantation was possible.