First, some psychiatric disorders and psychosocial variables do have an effect on transplant outcomes. Recent substance abuse, severe personality disorders, poor global function, and an avoidant coping style predict worse outcomes (2, 3). Second, in some cases, even high-risk patients can do well with expert management. Third, especially in such cases, good family support is invaluable. Fourth, a longitudinal relationship with the transplant team provides an opportunity to assess and modify psychosocial risks much better than evaluation at a single moment in time. Mr. A was undoubtedly a high-risk patient, but he had the benefit of devoted and expert psychiatric care, time to develop a relationship with his transplant cardiologist, and superb support from his family.