Extracorporeal membrane oxygenation (ECMO) is used as a salvage therapy in children with irreversible myocardial failure who may be candidates for heart transplantation (HTx) (at the Hospital for Sick Children). We retrospectively assessed outcomes of children wait-listed for HTx from ECMO, and risk factors for patients (pts) bridged to HTx from January 1990 through December 2005. Of 205 patients supported with cardiac ECMO, 46 were wait-listed for HTx. Sixteen patients died before HTx: eight died while wait-listed on ECMO; eight were delisted (clinical deterioration; all died); five were delisted (improved), and 25 (54%) underwent HTx from ECMO. Of 25 patients who underwent HTx (median age 7.0 years [10 days to 17 years]), 13 had myocarditis or cardiomyopathy, and 12 had congenital heart disease. Median ECMO duration was 6.7 days (3-18 days). Median follow-up was 4.3 years (0.2-10.6 years). Four patients died <1 week post-HTx, and 21 survived until hospital discharge (84%). Post-transplant survival was 67% and 52% at 1 and 5 years, respectively. Risk factors for early death were older age, higher body surface area, higher creatinine before and during ECMO, fungal infections, and exposure to blood products. In summary, few risk factors preclude HTx candidacy from ECMO. The impact of newer assist technology on ECMO, wait-list mortality, and HTx outcomes remains to be elucidated.