In recent years, the utility and value of pre-operative cardiac testing have been progressively brought into question. In contrast, the cardiac evaluation of candidates for solid organ transplantation remains very much the standard of care, justified by the resource-intensive and high-risk nature of both the surgery and the patient. To a great extent, perioperative guidelines that have diminished the importance of testing prior to other non-cardiac surgeries have not been applied broadly in the transplant scenario.