Good surgeons know that they have better outcomes if their patients are not too sick. Medical doctors think of surgery only when all other options have failed. A heart transplant surgeon wants to operate before the patient gets can’t live without it. Cardiologists, meanwhile, tend to hold on to their patients until they are at death’s door. Unfortunately, the sickest patients, the ones that need a transplant the most, tend to die even when we do operate, leaving the family asking why we didn't do something sooner. On the other end of the spectrum, somewhat paradoxically, the hypothetical best candidate for a transplant in terms of outcomes is a patient who is perfectly healthy. However, if the patient is not sick enough, he won’t feel any benefit from the procedure, leaving him justifiably asking if he needed it at all.